Provider Demographics
NPI:1679644819
Name:WAGNER, KURT ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:ARTHUR
Last Name:WAGNER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47 E CHICAGO AVE
Mailing Address - Street 2:SUITE 344
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-5325
Mailing Address - Country:US
Mailing Address - Phone:630-778-9500
Mailing Address - Fax:
Practice Address - Street 1:47 E CHICAGO AVE
Practice Address - Street 2:SUITE 344
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-5325
Practice Address - Country:US
Practice Address - Phone:630-778-9500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019021-0941223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry