Wagner, Michael A

Wagner, Michael A is an individual health care provider with primary practice located at 480 Broadway , Pawtucket RI 02860. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Wagner, Michael A can be contacted via phone (401) 728-6654.

Contact Information

Primary practice address
480 Broadway Pawtucket RI 02860
Fax: (701) 728-5726
Website:

Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 2342 Rhode Island

Profile Details

NPI number 1639114622
LBN Legal business name Wagner, Michael A
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 17th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1639114622 NPPES
Rhode Island MEDICAID MW02273

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