Provider Demographics
NPI:1801400106
Name:WAGLER, SAMANTHA (DDS)
Entity Type:Individual
Prefix:DR
First Name:SAMANTHA
Middle Name:
Last Name:WAGLER
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 1:80 HUFF AVE
Mailing Address - Street 2:SUITE 1
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601
Mailing Address - Country:US
Mailing Address - Phone:724-836-3368
Mailing Address - Fax:724-836-1209
Practice Address - Street 1:80 HUFF AVE
Practice Address - Street 2:SUITE 1
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601
Practice Address - Country:US
Practice Address - Phone:724-836-3368
Practice Address - Fax:724-836-1209
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098221223G0001X
PADS0433831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice