Provider Demographics
NPI:1952302309
Name:WAGGONER, FRANK T JR (DDS)
Entity Type:Individual
Prefix:
First Name:FRANK
Middle Name:T
Last Name:WAGGONER
Suffix:JR
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 1:615 GREEN ST NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30501-3319
Mailing Address - Country:US
Mailing Address - Phone:770-536-1012
Mailing Address - Fax:770-535-1980
Practice Address - Street 1:615 GREEN ST NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30501-3319
Practice Address - Country:US
Practice Address - Phone:770-536-1012
Practice Address - Fax:770-535-1980
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA78161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice