| NPI | 1770860595 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSHUA G WAGNER Dentist 307-856-3463 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: WY 1093) |
| Enumeration Date | 2011-11-08 |
| Last Update Date | 2011-11-08 |