Provider Demographics
NPI:1700070968
Name:WAGSTAFFE, NATALIE MARIE (DDS)
Entity Type:Individual
Prefix:DR
First Name:NATALIE
Middle Name:MARIE
Last Name:WAGSTAFFE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:NATALIE
Other - Middle Name:MARIE
Other - Last Name:WAGSTAFFE-STOUTE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:2411 CROFTON LN
Mailing Address - Street 2:20A
Mailing Address - City:CROFTON
Mailing Address - State:MD
Mailing Address - Zip Code:21114-1336
Mailing Address - Country:US
Mailing Address - Phone:410-721-0900
Mailing Address - Fax:410-721-0915
Practice Address - Street 1:2411 CROFTON LN
Practice Address - Street 2:20A
Practice Address - City:CROFTON
Practice Address - State:MD
Practice Address - Zip Code:21114-1336
Practice Address - Country:US
Practice Address - Phone:410-721-0900
Practice Address - Fax:410-721-0915
Is Sole Proprietor?:No
Enumeration Date:2007-08-30
Last Update Date:2007-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13991122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist