The Family Dentist

Primary specialty

DentistTaxonomy code 122300000X

License

2342 Issued in RI

Legal business name

THE FAMILY DENTIST

Practice address

480 Broadway
Pawtucket, RI 02860-1340

Phone

(401) 728-6654

Fax

(401) 728-5726

NPI assigned

Aug 21, 2008

Last updated

Aug 21, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Michael A. Wagner, DDSNPI 1639114622

Title

President

Phone

(401) 728-6654

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael A Wagner, DDS

  • Dentist
  • Pawtucket, RI
  • NPI 1639114622
  NPD (past) Authorized official
• Michele Gendron Siler, DDS

  • Dentist
  • Providence, RI
  • NPI 1164439014
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219276800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1219276800000",
    "number": "1013164920",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "480 BROADWAY",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028601340",
            "telephone_number": "401-728-6654",
            "fax_number": "401-728-5726"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "480 BROADWAY",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028601340",
            "telephone_number": "401-728-6654",
            "fax_number": "401-728-5726"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "THE FAMILY DENTIST",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-08-21",
        "last_updated": "2008-08-21",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "401-728-6654",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "RI",
            "license": "2342",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• The Arc of Blackstone Valley
• The Arc of Blackstone Valley
• The Arc of Blackstone Valley
• The Arc of Blackstone Valley
• The Eyeglass Store Inc (Family Eye Care Services)
• The Goodwell Practice LLC
• The House on Benefit
• The International Charter School
• The International Charter School
• The International Charter School

• Dentist in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• Dentist in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 21, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.