Provider Demographics
NPI:1205365756
Name:WAGGONER, EUGENA CURTIS (DDS)
Entity Type:Individual
Prefix:DR
First Name:EUGENA
Middle Name:CURTIS
Last Name:WAGGONER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1612 HUGUENOT RD
Mailing Address - Street 2:
Mailing Address - City:MIDLOTHIAN
Mailing Address - State:VA
Mailing Address - Zip Code:23113
Mailing Address - Country:US
Mailing Address - Phone:804-794-9789
Mailing Address - Fax:804-419-1059
Practice Address - Street 1:4710 PUDDLEDOCK ROAD
Practice Address - Street 2:
Practice Address - City:PRINCE GEORGE
Practice Address - State:VA
Practice Address - Zip Code:23875
Practice Address - Country:US
Practice Address - Phone:804-526-4822
Practice Address - Fax:804-419-1059
Is Sole Proprietor?:No
Enumeration Date:2017-06-08
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401415670122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist