Provider Demographics
NPI:1225128143
Name:STANTON F WAGGONER DDS PC
Entity type:Organization
Organization Name:STANTON F WAGGONER DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STANTON
Authorized Official - Middle Name:F
Authorized Official - Last Name:WAGGONER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-490-7772
Mailing Address - Street 1:13499 WETMORE ROAD
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78247
Mailing Address - Country:US
Mailing Address - Phone:210-490-7772
Mailing Address - Fax:210-490-8927
Practice Address - Street 1:13499 WETMORE ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78247
Practice Address - Country:US
Practice Address - Phone:210-490-7772
Practice Address - Fax:210-490-8927
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX153771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty