Active NPI
Brian James Waggle, DDS
- General Practice Dentistry
- Zanesville, OH
National Provider Identifier
1215090303
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 19787
- Practice address
- 4063 Northpointe Dr
Zanesville, OH 43701-7647 - Phone
- (740) 454-6644
- Fax
- (740) 588-0950
- NPI assigned
- Dec 19, 2006
- 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 | 19787 | OH | Primary |
Addresses
Primary practice location
4063 Northpointe Dr
Zanesville, OH 43701-7647
Mailing address
4063 Northpointe Dr
Zanesville, OH 43701-7647
Phone (740) 454-6644
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 0168214 | Medicaid | OH | |
| 311626180 | Other | OH | FEDERAL TAX ID |
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 |
|---|---|---|---|
| 19787 | OH | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166486400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1374537600000",
"number": "1215090303",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4063 NORTHPOINTE DR",
"city": "ZANESVILLE",
"state": "OH",
"postal_code": "437017647",
"telephone_number": "740-454-6644",
"fax_number": "740-588-0950"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4063 NORTHPOINTE DR",
"city": "ZANESVILLE",
"state": "OH",
"postal_code": "437017647",
"telephone_number": "740-454-6644",
"fax_number": "740-588-0950"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGLE",
"first_name": "BRIAN",
"middle_name": "JAMES",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-12-19",
"last_updated": "2013-07-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "OH",
"license": "19787",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0168214",
"state": "OH"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "311626180",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Zanesville, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 23, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.