| F John Wagner | |
|
7791 Mystic Lake Dr Lake MI 48632-9743 | |
| (989) 544-2096 | |
| Not Available |
| Full Name | F John Wagner |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7791 Mystic Lake Dr, Lake, Michigan |
| Authorized Official Name and Position | Frederic John Wagner (PRES) |
| Authorized Official Contact | 9895442096 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| F John Wagner 7791 Mystic Lake Dr Lake MI 48632-9743 Ph: (989) 544-2096 | F John Wagner 7791 Mystic Lake Dr Lake MI 48632-9743 Ph: (989) 544-2096 |
| NPI Number | 1568522910 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568522910 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 10266 (Michigan) | Primary |