| NPI | 1043402894 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | RICHARD WAGNER Orthodontist 712-258-0501 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223X0400X Dentist, Orthodontics and Dentofacial Orthopedics (Licence: IA 6637) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2007-08-15 |