Provider Demographics
NPI:1164439840
Name:WAGNER, AARON WILLIAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:WILLIAM
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 1:260 ELMIRA STREET
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:PA
Mailing Address - Zip Code:16947-1204
Mailing Address - Country:US
Mailing Address - Phone:570-297-3388
Mailing Address - Fax:570-297-4859
Practice Address - Street 1:260 ELMIRA ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:PA
Practice Address - Zip Code:16947-1204
Practice Address - Country:US
Practice Address - Phone:570-297-3388
Practice Address - Fax:570-297-4859
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS017613L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist