Provider Demographics
NPI:1952668204
Name:WAGNILD, GALEN W (DDS)
Entity Type:Individual
Prefix:DR
First Name:GALEN
Middle Name:W
Last Name:WAGNILD
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:450 SUTTER ST
Mailing Address - Street 2:SUITE 1636
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-4206
Mailing Address - Country:US
Mailing Address - Phone:415-956-5162
Mailing Address - Fax:415-956-0166
Practice Address - Street 1:450 SUTTER ST
Practice Address - Street 2:SUITE 1636
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-4206
Practice Address - Country:US
Practice Address - Phone:415-956-5162
Practice Address - Fax:415-956-0166
Is Sole Proprietor?:No
Enumeration Date:2012-04-11
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA254611223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics