| Wagner Family Dentistry | |
|
2803 Ne Everett St Portland OR 97232-3246 | |
| (503) 239-5115 | |
| (503) 231-6480 |
| Full Name | Wagner Family Dentistry |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2803 Ne Everett St, Portland, Oregon |
| Authorized Official Name and Position | Robert Frederick Wagner (OWNER/PRESIDENT) |
| Authorized Official Contact | 5032395115 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Wagner Family Dentistry 2803 Ne Everett St Portland OR 97232-3246 Ph: (503) 239-5115 | Wagner Family Dentistry 2803 Ne Everett St Portland OR 97232-3246 Ph: (503) 239-5115 |
| NPI Number | 1932499035 |
|---|---|
| Provider Enumeration Date | 04/11/2011 |
| Last Update Date | 06/08/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932499035 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | D7549 (Oregon) | Primary |
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