Active NPI
Elizabeth M Waggener, D.D.S.
- Dentist
- Somerville, TN
National Provider Identifier
1205045275
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 7136
- Practice address
- 305 Lake Dr
Somerville, TN 38068-9718 - Phone
- (901) 465-2714
- Fax
- (901) 465-6266
- NPI assigned
- May 22, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 7136 | TN | Primary |
Addresses
Primary practice location
305 Lake Dr
Somerville, TN 38068-9718
Mailing address
8845 Oak Hedge CV
Cordova, TN 38018-6957
Phone (901) 758-2537
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 7136 | TN | MD | Medical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179792000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1205045275",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8845 OAK HEDGE CV",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380186957",
"telephone_number": "901-758-2537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "305 LAKE DR",
"city": "SOMERVILLE",
"state": "TN",
"postal_code": "380689718",
"telephone_number": "901-465-2714",
"fax_number": "901-465-6266"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGENER",
"first_name": "ELIZABETH",
"middle_name": "M",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TN",
"license": "7136",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Somerville, TN
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.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.