Active NPI
Dale Eillott Wagman, D.D.S.
- Dentist
- Howell, MI
National Provider Identifier
1093044125
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 11938
- Practice address
- 2972 Weatherly Rd
Howell, MI 48843-8880 - Phone
- (517) 546-6254
- NPI assigned
- Dec 20, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 11938 | MI | Primary |
Addresses
Primary practice location
2972 Weatherly Rd
Howell, MI 48843-8880
Mailing address
2972 Weatherly Rd
Howell, MI 48843-8880
Phone (517) 546-6254
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11938 | MI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1261267200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1261267200000",
"number": "1093044125",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2972 WEATHERLY RD",
"city": "HOWELL",
"state": "MI",
"postal_code": "488438880",
"telephone_number": "517-546-6254"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2972 WEATHERLY RD",
"city": "HOWELL",
"state": "MI",
"postal_code": "488438880",
"telephone_number": "517-546-6254"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGMAN",
"first_name": "DALE",
"middle_name": "EILLOTT",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-12-20",
"last_updated": "2009-12-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "MI",
"license": "11938",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Howell, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.