Provider Demographics
NPI:1528182680
Name:WAGNER, JOSHUA GRANT (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:GRANT
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 1:7456 S SIMMS ST
Mailing Address - Street 2:STE A-1
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80127-3286
Mailing Address - Country:US
Mailing Address - Phone:720-981-5868
Mailing Address - Fax:720-981-5809
Practice Address - Street 1:7456 S SIMMS ST
Practice Address - Street 2:STE A-1
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80127-3286
Practice Address - Country:US
Practice Address - Phone:720-981-5868
Practice Address - Fax:720-981-5809
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10931223G0001X
CO00202788122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice