Wagner, Richard W
Wagner, Richard W is an individual health care provider with primary practice located at 3012 Hamilton Blvd , Sioux City IA 51104. He recently has only one registered license in Dental Providers / Orthodontics and Dentofacial Orthopedics, which is considered as his primary health care specialty. Wagner, Richard W can be contacted via phone (712) 258-0501.Contact Information
Primary practice address
3012 Hamilton Blvd
Sioux City IA 51104
Phone: (712) 258-0501
Fax: (712) 258-1461
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Orthodontics and Dentofacial Orthopedics | 1223X0400X | 6637 | Iowa |
Profile Details
| NPI number | 1710050893 |
|---|---|
| LBN Legal business name | Wagner, Richard W |
| Credentials | DDS MS |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 16th, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1710050893 | NPPES |
| Nebraska | MEDICAID | 10025343600 | |
| Nebraska | MEDICAID | 0207233 | |
| Nebraska | MEDICAID | 7900130 |
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