Provider Demographics
NPI:1316510928
Name:WAGNER, CELINA MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:CELINA
Middle Name:MARIE
Last Name:WAGNER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:CELINA
Other - Middle Name:MARIE
Other - Last Name:PRINCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6236 EMERALD LAKE DR
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532-4537
Mailing Address - Country:US
Mailing Address - Phone:248-210-8661
Mailing Address - Fax:
Practice Address - Street 1:9072 LORRAINE RD
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-6101
Practice Address - Country:US
Practice Address - Phone:228-896-1840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS111700122300000X
CA106667122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist