Active NPI
Eugena Curtis Waggoner, DDS
- Dentist
- Prince George, VA
National Provider Identifier
1205365756
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 0401415670
- Practice address
- 4710 Puddledock Road
Prince George, VA 23875 - Phone
- (804) 526-4822
- Fax
- (804) 419-1059
- NPI assigned
- Jun 8, 2017
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 0401415670 | VA | Primary |
Addresses
Primary practice location
4710 Puddledock Road
Prince George, VA 23875
Mailing address
1612 Huguenot Rd
Midlothian, VA 23113
Phone (804) 794-9789
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: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
- Opted out of Medicare
- Yes, effective May 16, 2018 through May 16, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0401415670 | VA | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Virginia Family Dentistry PC | 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.
-
- General Practice Dentistry
- Midlothian, VA
- NPI 1750435970
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1496880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1629936000000",
"number": "1205365756",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1612 HUGUENOT RD",
"city": "MIDLOTHIAN",
"state": "VA",
"postal_code": "23113",
"telephone_number": "804-794-9789",
"fax_number": "804-419-1059"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4710 PUDDLEDOCK ROAD",
"city": "PRINCE GEORGE",
"state": "VA",
"postal_code": "23875",
"telephone_number": "804-526-4822",
"fax_number": "804-419-1059"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "EUGENA",
"middle_name": "CURTIS",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-06-08",
"last_updated": "2021-08-26",
"certification_date": "2021-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "VA",
"license": "0401415670",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Prince George, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 2021; 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; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.