Robert H Wagner Family Dentist S.C.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

ROBERT H WAGNER FAMILY DENTIST S.C.

Practice address

2830 Curry Court
Suite 1
Green Bay, WI 54311

Phone

(920) 432-7230

Fax

(920) 432-6948

NPI assigned

Jul 12, 2019

Organization subpart

No

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

Authorized official

Name

Dr. Robert Harold Wagner, DDS

Title

Dentist/Owner

Phone

(920) 432-7230

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• S. Patrick Maraka, DDS

  • Dentist
  • Green Bay, WI
  • NPI 1972764553
  NPD (past)
• Sara Jane Weber, DDS

  • Dentist
  • Green Bay, WI
  • NPI 1396150777
  NPD (past)

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

{
    "created_epoch": "1562889600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1562889600000",
    "number": "1124670898",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2830 CURRY COURT",
            "address_2": "SUITE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54311",
            "telephone_number": "920-432-7230",
            "fax_number": "920-432-6948"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2830 CURRY COURT",
            "address_2": "SUITE 1",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "54311",
            "telephone_number": "920-432-7230",
            "fax_number": "920-432-6948"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERT H WAGNER FAMILY DENTIST S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-07-12",
        "last_updated": "2019-07-12",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "HAROLD",
        "authorized_official_title_or_position": "DENTIST/OWNER",
        "authorized_official_telephone_number": "920-432-7230",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33487700",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Shelley Riutta, MSE
• Shiloe Elaine Rivas
• Sandra D Rivera, LPC IT
• Shelby A. Robbins, CSAC
• Teresa A Robbins, LPC, CSAC
• Ashley J Roberts, OTR
• Audrey Roberts
• Amanda J Robertson, PA-C
• Bruce J. Robertson, PHD
• Cheryl M Robertson

• General Practice Dentistry in Green Bay, WI
• Providers in Green Bay, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2019; 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.