| Nicholas J Wagner, Dds, Llc | |
|
800 Office Park Dr Boonville IN 47601-8601 | |
| (812) 897-4889 | |
| Not Available |
| Full Name | Nicholas J Wagner, Dds, Llc |
|---|---|
| Speciality | Dentist |
| Location | 800 Office Park Dr, Boonville, Indiana |
| Authorized Official Name and Position | Nicholas J Wagner (DENTIST/OWNER) |
| Authorized Official Contact | 8128974889 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Nicholas J Wagner, Dds, Llc 800 Office Park Dr Boonville IN 47601-8601 Ph: (812) 897-4889 | Nicholas J Wagner, Dds, Llc 800 Office Park Dr Boonville IN 47601-8601 Ph: (812) 897-4889 |
| NPI Number | 1306231717 |
|---|---|
| Provider Enumeration Date | 04/02/2015 |
| Last Update Date | 04/02/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306231717 | NPI | - | NPPES |
| 1023338480 | Medicaid | IN | |
| 1588740815 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 12011465A (Indiana) | Primary |
Warrick Park Dental Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 800 Office Park Dr, Boonville, IN 47601 Phone: 812-897-4889 Fax: 812-897-8113 | |
Kolb & Kolb Dds Llc Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 602 W Locust St, Boonville, IN 47601 Phone: 812-897-3470 Fax: 812-897-0068 | |
Warrick Park Dental, Llp Dental Clinic Medicare: Not Enrolled in Medicare Practice Location: 800 Office Park Dr, Boonville, IN 47601 Phone: 812-897-4889 Fax: 812-897-8113 |