Provider Demographics
NPI:1033265673
Name:WAGGONER BICK, RESEE ADAIR (DMD)
Entity Type:Individual
Prefix:
First Name:RESEE
Middle Name:ADAIR
Last Name:WAGGONER BICK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:622 SOUTH MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:RED LION
Mailing Address - State:PA
Mailing Address - Zip Code:17356-2603
Mailing Address - Country:US
Mailing Address - Phone:717-244-8537
Mailing Address - Fax:717-244-6711
Practice Address - Street 1:622 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:RED LION
Practice Address - State:PA
Practice Address - Zip Code:17356-2603
Practice Address - Country:US
Practice Address - Phone:717-244-8537
Practice Address - Fax:717-244-6711
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS030404L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice