Kent Wagner Jr DDS PC

Primary specialty

DentistTaxonomy code 122300000X

License

4799 Issued in NV

Legal business name

KENT WAGNER JR DDS PC

Practice address

2045 Village Center Circle
Las Vegas, NV 89134

Phone

(702) 878-5599

Fax

(702) 878-0173

NPI assigned

Aug 4, 2006

Organization subpart

No

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

Authorized official

Name

Ronald Kent Wagner Jr., DDS

Title

Dentist Owner

Phone

(702) 878-5599

Specialties & licenses 1

Addresses

Other identifiers 1

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

{
    "created_epoch": "1154649600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1336157270",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2045 VILLAGE CENTER CIRCLE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89134",
            "telephone_number": "702-878-5599",
            "fax_number": "702-878-0173"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2045 VILLAGE CENTER CIRCLE",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89134",
            "telephone_number": "702-878-5599",
            "fax_number": "702-878-0173"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KENT WAGNER JR DDS PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-04",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "RONALD",
        "authorized_official_middle_name": "KENT",
        "authorized_official_title_or_position": "DENTIST OWNER",
        "authorized_official_telephone_number": "702-878-5599",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NV",
            "license": "4799",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UNITED CONCORIDA PROVIDER",
            "identifier": "1779641",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas Kenny, D.M.D.
• Alvin Kenon
• Kenshia McKinzie
• Emily Kenslow
• Kent L. Phillips, D.D.S., M.S., LTD.
• Antionetta Kent
• Mackenzie Rachel Kent, OTD
• Melissa Kenyon, BCBA, LBA
• Rachel Keo, MA, LMHC, CPC, NCC
• Deborah Keovilay

• Dentist in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• Dentist in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.