Scott William Wagner, DDS
Dentist, General Practice in Tulsa, OK. Individual provider (NPI-1).
NPI number1902909005
StatusActive
Last updated in NPPESJun 5, 2014
Details
- NPI
- 1902909005
- Entity type
- Individual (NPI-1)
- Name
- Scott William Wagner
- Credential
- DDS
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- Sep 6, 2006
- Last updated
- Jun 5, 2014
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 1223G0001X | Dentist, General Practice | 5335 | OK | Yes |
Practice location
9035 East 62nd Street SouthTulsa, OK 74133
Phone 918-622-3915 · Fax 918-662-3922
Mailing address
9035 E 62nd St SoTulsa, OK 74133
Phone 918-622-3915 · Fax 918-994-6870
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