Elyse Anne Wagner, DMD

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

DN1858351 Issued in MA

Practice address

93 Union St Ste 402
Newton Centre, MA 02459-2241

Phone

(179) 650-0606

NPI assigned

May 24, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Newton Dental Associates

  • Periodontics
  • Newton Center, MA
  • NPI 1144276601
  NPD (past)

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

{
    "created_epoch": "1527120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1620345600000",
    "number": "1023509007",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "93 UNION ST STE 402",
            "city": "NEWTON CENTRE",
            "state": "MA",
            "postal_code": "024592241",
            "telephone_number": "617-965-0060"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "93 UNION ST STE 402",
            "city": "NEWTON CENTRE",
            "state": "MA",
            "postal_code": "024592241",
            "telephone_number": "179-650-0606"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ELYSE",
        "middle_name": "ANNE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-24",
        "last_updated": "2021-05-07",
        "certification_date": "2021-05-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MA",
            "license": "DN1858351",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sheila Marilyn Statlender, PH.D.
• Mark Robert Steward, PH.D.
• James Peter Stewart, DPM
• Rebecca Colacchio Thompson, MSW, LICSW
• Erika Vargas, LMHC
• John Walsh
• Malarie Elizabeth Warren, RDN, LDN
• Ronan Wolfsdorf, MSW, LICSW
• Nelson Wong
• Jennie Elizabeth Xie, PHARMD

• Prosthodontics in Newton Centre, MA
• Providers in Newton Centre, MA by specialty
• Prosthodontics in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2021; 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.