Provider Demographics
NPI:1891851424
Name:WAGENKNECHT, KARL (DMD)
Entity Type:Individual
Prefix:
First Name:KARL
Middle Name:
Last Name:WAGENKNECHT
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 VILLARD ST
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97403-1955
Mailing Address - Country:US
Mailing Address - Phone:541-342-5578
Mailing Address - Fax:541-302-6399
Practice Address - Street 1:1380 VILLARD ST
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97403-1955
Practice Address - Country:US
Practice Address - Phone:541-342-5578
Practice Address - Fax:541-302-6399
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR52291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics