Chance P Wagner, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

063380 Issued in NY

Practice address

102 W Seneca St
Manlius, NY 13104-2480

Phone

(315) 682-8400

NPI assigned

Apr 19, 2022

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1650326400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1775260800000",
    "number": "1073256871",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "102 W SENECA ST",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131042480",
            "telephone_number": "315-682-8400"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "102 W SENECA ST",
            "city": "MANLIUS",
            "state": "NY",
            "postal_code": "131042480",
            "telephone_number": "315-682-8400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "CHANCE",
        "middle_name": "P",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-04-19",
        "last_updated": "2026-04-04",
        "certification_date": "2026-04-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NY",
            "license": "063380",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Heidi Elizabeth Urciuoli
• Shawna M Valenta, PHARM D
• Kristen Joy Vieau, AUD
• Vihaan Behavioral Health & Forensic Services
• Village of Manlius
• Walgreen Co (Rite Aid #10750)
• Walgreen Co (Walgreens #17643)
• Christina Celia Walton, DO
• Anna Katherine Kim Waters
• Wendy A West Pidkaminy, LCSW-R

• General Practice Dentistry in Manlius, NY
• Providers in Manlius, NY by specialty
• General Practice Dentistry in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2026; 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.