BRANDON MARK WAGNER

BOISE, ID
NPI1265002901
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist General Practice
(Licence: ID  D-5306)
Enumeration Date2021-06-25
Last Update Date2022-05-02
Business Address
DR. BRANDON MARK WAGNER DDS
403 S 11TH ST STE 200
BOISE, ID 83702-6968
Phone number: 208-342-3440
Mailing Address
DR. BRANDON MARK WAGNER DDS
10926 RAGSDALE RD
LOMA LINDA, CA 92354-6546
Phone number: 951-236-0882
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