F John Wagner | |
7791 Mystic Lake Dr Lake MI 48632-9743 | |
(989) 544-2096 | |
Not Available |
Full Name | F John Wagner |
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Speciality | Clinic/center - Dental |
Location | 7791 Mystic Lake Dr, Lake, Michigan |
Authorized Official Name and Position | Frederic John Wagner (PRES) |
Authorized Official Contact | 9895442096 |
Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
Mailing Address | Practice Location Address |
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F John Wagner 7791 Mystic Lake Dr Lake MI 48632-9743 Ph: (989) 544-2096 | F John Wagner 7791 Mystic Lake Dr Lake MI 48632-9743 Ph: (989) 544-2096 |
NPI Number | 1568522910 |
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Provider Enumeration Date | 12/08/2006 |
Last Update Date | 08/22/2020 |
Identifier | Type | State | Issuer |
---|---|---|---|
1568522910 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QD0000X | Clinic/center - Dental | 10266 (Michigan) | Primary |