Provider Demographics
NPI:1407305022
Name:DUARTE, WAGNER RODRIGUES (DDS)
Entity Type:Individual
Prefix:DR
First Name:WAGNER
Middle Name:RODRIGUES
Last Name:DUARTE
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 1:1600 SW ARCHER RD, ROOM D10-6 PO BOX 100434
Mailing Address - Street 2:UNIVERSITY OF FLORIDA, DEPARTMENT OF PERIODONTOLOGY
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32610-0434
Mailing Address - Country:US
Mailing Address - Phone:352-273-8360
Mailing Address - Fax:
Practice Address - Street 1:1600 SW ARCHER RD
Practice Address - Street 2:ROOM D10-6
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32610-0434
Practice Address - Country:US
Practice Address - Phone:352-273-8360
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL6381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics