Active NPI
Lauren M Wagner, DMD
- General Practice Dentistry
- Wentzville, MO
National Provider Identifier
1124696497
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2021021151
- Practice address
- 1126 W Pearce Blvd Ste 110
Wentzville, MO 63385-1053 - Phone
- (636) 327-5188
- Fax
- (636) 332-9223
- NPI assigned
- Jun 14, 2021
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2021021151 | MO | Primary |
Addresses
Primary practice location
1126 W Pearce Blvd Ste 110
Wentzville, MO 63385-1053
Mailing address
15363 Red Willow CT
Chesterfield, MO 63017-5426
Phone (414) 975-6675
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 |
|---|---|---|---|
| 2021021151 | MO | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas C. Delaney DMD PC | General Practice | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1623628800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636588800000",
"number": "1124696497",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "15363 RED WILLOW CT",
"city": "CHESTERFIELD",
"state": "MO",
"postal_code": "630175426",
"telephone_number": "414-975-6675"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1126 W PEARCE BLVD STE 110",
"city": "WENTZVILLE",
"state": "MO",
"postal_code": "633851053",
"telephone_number": "636-327-5188",
"fax_number": "636-332-9223"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LAUREN",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-06-14",
"last_updated": "2021-11-11",
"certification_date": "2021-11-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MO",
"license": "2021021151",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wentzville, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 11, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.