Peter Louis Wagner, DMD

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DE60732747 Issued in WA

Practice address

1327 Bishop Rd
Chehalis, WA 98532-9263

Phone

(360) 748-6636

NPI assigned

Jan 31, 2017

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Wagner Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Chehalis, WA
  • NPI 1003465964
  NPD

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

{
    "created_epoch": "1485820800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1726704000000",
    "number": "1235676008",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1327 BISHOP RD",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985329263",
            "telephone_number": "360-748-6636"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1327 BISHOP RD",
            "city": "CHEHALIS",
            "state": "WA",
            "postal_code": "985329263",
            "telephone_number": "360-748-6636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "PETER",
        "middle_name": "LOUIS",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-01-31",
        "last_updated": "2024-09-19",
        "certification_date": "2024-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D10580",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "WA",
            "license": "DE60732747",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paulo Vianney Vilela Rodrigues, PHD, MSN, RN, BS.
• Veronica Villarreal
• Ali Katherine Vyhmeister, MD
• Wagner Orthodontics
• Peter C. Wagner, D.M.D.
• Aimee Therese Wagonblast, ARNP
• Wal-Mart Stores, Inc (Vision Center 30-2249)
• Walgreen Co (Walgreens #10395)
• Eva Donna Walker, O.D.
• Richard R Walker, DDS

• Orthodontics and Dentofacial Orthopedics Dentistry in Chehalis, WA
• Providers in Chehalis, WA by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 19, 2024; 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.