Active NPI
Jeffrey Paul Wagner, DDS
- Dentist
- Albuquerque, NM
National Provider Identifier
1174580120
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 1265
- Practice address
- 1501 San Pedro Dr SE
Albuquerque, NM 87108-5153 - Phone
- (505) 256-2778
- NPI assigned
- Apr 26, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 1265 | NM | Primary |
Addresses
Primary practice location
1501 San Pedro Dr SE
Albuquerque, NM 87108-5153
Mailing address
7527 Jacobo Dr NE
Albuquerque, NM 87109-6425
Phone (505) 821-4415
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 |
|---|---|---|---|
| 1265 | NM | MD | Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146009600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1174580120",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7527 JACOBO DR NE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871096425",
"telephone_number": "505-821-4415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1501 SAN PEDRO DR SE",
"city": "ALBUQUERQUE",
"state": "NM",
"postal_code": "871085153",
"telephone_number": "505-256-2778"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "JEFFREY",
"middle_name": "PAUL",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-26",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NM",
"license": "1265",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Albuquerque, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.