Wagner, Kuntz & Grabouski

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

6637 Issued in IA

Legal business name

WAGNER, KUNTZ & GRABOUSKI

Practice address

3021 Hamilton Blvd
Sioux City, IA 51104-2407

Phone

(712) 258-0501

Fax

(712) 258-1461

NPI assigned

Aug 15, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Richard Wagner, DDS

Title

Orthodontist

Phone

(712) 258-0501

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

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

{
    "created_epoch": "1187136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1187136000000",
    "number": "1043402894",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3021 HAMILTON BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511042407",
            "telephone_number": "712-258-0501",
            "fax_number": "712-258-1461"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3021 HAMILTON BLVD",
            "city": "SIOUX CITY",
            "state": "IA",
            "postal_code": "511042407",
            "telephone_number": "712-258-0501",
            "fax_number": "712-258-1461"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER, KUNTZ & GRABOUSKI",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-15",
        "last_updated": "2007-08-15",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "RICHARD",
        "authorized_official_title_or_position": "ORTHODONTIST",
        "authorized_official_telephone_number": "712-258-0501",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "IA",
            "license": "6637",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "10025343600",
            "state": "NE"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Wagner Chiropractic P.C.
• David V Wagner, MD
• Hailey Wagner
• Jason Leigh Wagner, L.M.H.C.
• Kelly Jean Wagner, LMHC
• Richard W Wagner Jr., DDS MS
• Wallace J Wagner
• Wal-Mart Stores, Inc. (Vision Center 30-1361)
• Wal-Mart Stores, Inc. (Vision Center 30-3590)
• Rebecca E Walding, ARNP

• Orthodontics and Dentofacial Orthopedics Dentistry in Sioux City, IA
• Providers in Sioux City, IA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2007; 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.