Spencer B Wagner DMD PC

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

3192 Issued in SC

Legal business name

SPENCER B WAGNER DMD PC

Practice address

1987 Allendale Fairfax Hwy
Fairfax, SC 29827-9137

Phone

(803) 632-3301

Fax

(803) 632-1240

NPI assigned

Mar 29, 2006

Last updated

Oct 7, 2008By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Spencer B Wagner, DMD

Title

Dentist

Phone

(803) 632-3301

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Vivien Rose Ebert, DMD

  • General Practice Dentistry
  • Fairfax, SC
  • NPI 1962230789
  NPD (past)

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

{
    "created_epoch": "1143590400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1223337600000",
    "number": "1205897378",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 830",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298270830",
            "telephone_number": "803-632-3301",
            "fax_number": "803-632-1240"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1987 ALLENDALE FAIRFAX HWY",
            "city": "FAIRFAX",
            "state": "SC",
            "postal_code": "298279137",
            "telephone_number": "803-632-3301",
            "fax_number": "803-632-1240"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPENCER B WAGNER DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-03-29",
        "last_updated": "2008-10-07",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "SPENCER",
        "authorized_official_middle_name": "B",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "803-632-3301",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "SC",
            "license": "3192",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robert M. Haberkorn DDS
• Lucille Miley Sanders, CFNP
• Vanessa Simmons
• Stacey K Smith, RPH
• Southern Oaks Therapy Services LLC
• Troy Wayne Spires, NP
• Allison A Stanley, M.S.N.,A.C.N.P.
• Katherine Borger Swearingen, PT
• Michael Robert Torkelson, M. D.
• Wanda W Tutt, LRD

• Dental Clinic/Center in Fairfax, SC
• Providers in Fairfax, SC by specialty
• Dental Clinic/Center in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 7, 2008; 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.