NPIMap

Organization Active NPI

Wagner Family Dental

  • Dentist
  • Jasper, IN
National Provider Identifier
1104209790
Registry record updated Jul 1, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
12010568A Issued in IN
Legal business name
WAGNER FAMILY DENTAL
Practice address
4115 Mannheim Rd
Jasper, IN 47546-2964
Phone
(812) 482-4347
NPI assigned
Jul 1, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 1, 2015

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

Authorized official

Name
Dr. Brian M. Wagner, DDS
Title
Owner
Phone
(812) 482-4347

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 12010568A IN Primary

Addresses

Primary practice location

4115 Mannheim Rd
Jasper, IN 47546-2964

Mailing address

PO Box 712
Jasper, IN 47547-0712
Phone (812) 482-4347

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1435708800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1435708800000",
    "number": "1104209790",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 712",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475470712",
            "telephone_number": "812-482-4347"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4115 MANNHEIM RD",
            "city": "JASPER",
            "state": "IN",
            "postal_code": "475462964",
            "telephone_number": "812-482-4347"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGNER FAMILY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-07-01",
        "last_updated": "2015-07-01",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "M.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-482-4347",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "IN",
            "license": "12010568A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jasper, IN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2015; 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.