Rudolph Michael Wagner, D.M.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

21125 Issued in FL

Practice address

2595 Tampa Rd Ste I
Palm Harbor, FL 34684-3131

Phone

(727) 785-8847

Fax

(277) 785-9372

NPI assigned

May 20, 2009

Last updated

Jul 20, 2021By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Rudolph M. Wagner, DMD, PLLC

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Palm Harbor, FL
  • NPI 1679146435
  NPD Authorized official
• Paul R. Duryea DDS Ms PA

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Palm Harbor, FL
  • NPI 1891822490
  NPD (past)
• Brian L Maynor D.D.S., PLLC

  dba Crosscreek Family Dentistry

  • General Practice Dentistry
  • Roanoke Rapids, NC
  • NPI 1194212456
  NPD (past)

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

{
    "created_epoch": "1242777600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1626739200000",
    "number": "1154556132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2595 TAMPA RD STE I",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346843131",
            "telephone_number": "727-785-8847"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2595 TAMPA RD STE I",
            "city": "PALM HARBOR",
            "state": "FL",
            "postal_code": "346843131",
            "telephone_number": "727-785-8847",
            "fax_number": "277-785-9372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RUDOLPH",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-05-20",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "21125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VMD Primary Providers Central Florida PLLC
• Jacqueline Vogt, PHARMD
• Volcare Medical LLC (Bay Regional Urgent Care)
• Jessica Ann Vold
• Michael Vollant, DO
• Wal-Mart Stores East LP (Walmart Pharmacy 10-3414)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-1513)
• Walgreen Co (Walgreens #07931)
• Walgreen Co (Walgreens #01189)
• Walgreen Co (Walgreens #04124)

• Orthodontics and Dentofacial Orthopedics Dentistry in Palm Harbor, FL
• Providers in Palm Harbor, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.

Verify at the official NPI Registry.