Active NPI
Dale F. Wagner, D.D.S.
- General Practice Dentistry
- Whittier, CA
National Provider Identifier
1184846933
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 26242
- Practice address
- 11506 Broadway
Whittier, CA 90601-3105 - Phone
- (562) 695-8718
- Fax
- (562) 692-4006
- NPI assigned
- May 2, 2007
- Sex
- Male
- Sole proprietor
- Yes
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 | 26242 | CA | Primary |
Addresses
Primary practice location
11506 Broadway
Whittier, CA 90601-3105
Mailing address
11506 Broadway
Whittier, CA 90601-3105
Phone (562) 695-8718
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 226242 | Other | CA | DELTA DENTAL PROVIDER # |
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 |
|---|---|---|---|
| 26242 | CA | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thomas R Gonzales, D.D.S. | 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.
-
- Customized Equipment (DME)
- Whittier, CA
- NPI 1043530736
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178064000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1184846933",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11506 BROADWAY",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906013105",
"telephone_number": "562-695-8718",
"fax_number": "562-692-4006"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11506 BROADWAY",
"city": "WHITTIER",
"state": "CA",
"postal_code": "906013105",
"telephone_number": "562-695-8718",
"fax_number": "562-692-4006"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "DALE",
"middle_name": "F.",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-05-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "26242",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DELTA DENTAL PROVIDER #",
"identifier": "226242",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Whittier, CA
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.