Bagley Dental

Primary specialty

DentistTaxonomy code 122300000X

License

10965 Issued in MN

Legal business name

BAGLEY DENTAL

Practice address

13 Main Ave N
Bagley, MN 56621-0299

Phone

(218) 964-6571

Fax

(218) 694-6555

NPI assigned

Dec 20, 2007

Last updated

Dec 20, 2007By 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

Roxane Lynn Waggoner

Title

Office Manager

Phone

(218) 694-6571

Specialties & licenses 3

Addresses

Practitioners 2

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.

• Mary Elizabeth Jones, DDS

  • General Practice Dentistry
  • Bagley, MN
  • NPI 1992875850
  NPD (past)
• Jill Sandwick Nelson, DDS

  • General Practice Dentistry
  • Bagley, MN
  • NPI 1225108186
  NPD (past)

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

{
    "created_epoch": "1198108800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1198108800000",
    "number": "1407030984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 299",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "566210299",
            "telephone_number": "218-964-6571",
            "fax_number": "218-694-6555"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13 MAIN AVE N",
            "city": "BAGLEY",
            "state": "MN",
            "postal_code": "566210299",
            "telephone_number": "218-964-6571",
            "fax_number": "218-694-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BAGLEY DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-12-20",
        "last_updated": "2007-12-20",
        "status": "A",
        "authorized_official_last_name": "WAGGONER",
        "authorized_official_first_name": "ROXANE",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "218-694-6571"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "10967",
            "primary": false
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "10965",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "10792",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Bagley Chiropractic Clinic, P.a.
• Bagley Isd #162
• Megan Ann Beck, OTR/L
• Megan Dale Bellefy
• Bemidji Area Program for Recovery, Inc. (Bemidji Area Program for Recovery Bagley Office)
• Kristyn Faith Bergh

• Dentist in Bagley, MN
• Providers in Bagley, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2007; 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.