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
Phone: (401) 728-6654
Fax: (701) 728-5726
Website:
Health care specialties
| Specialty | Code | License # | 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 13th, 2026 - about 4 months 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1639114622 | NPPES |
| Rhode Island | MEDICAID | MW02273 |
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