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1770700957
RICHARD M WAGNER
RACINE, WI
NPI
1770700957
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
No
Primary Taxonomy
1223S0112X Dentist, Oral and Maxillofacial Surgery
(Licence: WI 3092)
Enumeration Date
2007-04-19
Last Update Date
2007-07-08
Business Address
Dr. RICHARD M WAGNER DDS
1925 SOUTH GREEN BAY RD
RACINE, WI 53406-4654
Phone number: 262-634-4646
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Mailing Address
Dr. RICHARD M WAGNER DDS
1925 SOUTH GREEN BAY RD
RACINE, WI 53406-4654
Phone number: 262-634-4646
Copy
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