Provider Demographics
NPI:1114017241
Name:WAGNER, ROBERT SCOTT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SCOTT
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2723 S WALTER REED DR
Mailing Address - Street 2:UNIT A
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22206-1266
Mailing Address - Country:US
Mailing Address - Phone:703-298-3020
Mailing Address - Fax:
Practice Address - Street 1:254 CAFFERTY RD
Practice Address - Street 2:
Practice Address - City:PIPERSVILLE
Practice Address - State:PA
Practice Address - Zip Code:18947-9337
Practice Address - Country:US
Practice Address - Phone:610-294-7994
Practice Address - Fax:610-294-7995
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA6248122300000X
NY051232122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist