| NPI | 1003452202 |
|---|---|
| Doing Business As | MICHAEL WAGNER DDS |
| Entity Type | Organization |
| Authorized Contact | DAYA BHAT Dentist/Owner 312-315-7604 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD0000X Clinic/Center, Dental |
| Enumeration Date | 2019-11-22 |
| Last Update Date | 2019-11-22 |