Provider Demographics
NPI:1699847335
Name:DAVID A. WAGNER, DMD, PA
Entity type:Organization
Organization Name:DAVID A. WAGNER, DMD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAGNER
Authorized Official - Suffix:SR
Authorized Official - Credentials:DMD
Authorized Official - Phone:828-894-8291
Mailing Address - Street 1:PO BOX 275
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NC
Mailing Address - Zip Code:28722-0275
Mailing Address - Country:US
Mailing Address - Phone:828-894-8291
Mailing Address - Fax:828-894-5124
Practice Address - Street 1:43 EAST MILLS STREET
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NC
Practice Address - Zip Code:28722
Practice Address - Country:US
Practice Address - Phone:828-894-8291
Practice Address - Fax:828-894-5124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC015MPOtherBCBS