Susan Elaine Wagner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

12008739 Issued in IN

Practice address

8849 Shelby St
A-2
Indianapolis, IN 46227-7508

Phone

(317) 881-4000

Fax

(317) 888-1762

NPI assigned

Mar 6, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1173139200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1417087982",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8849 SHELBY ST",
            "address_2": "A-2",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462277508",
            "telephone_number": "317-881-4000",
            "fax_number": "317-888-1762"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8849 SHELBY ST",
            "address_2": "A-2",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462277508",
            "telephone_number": "317-881-4000",
            "fax_number": "317-888-1762"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SUSAN",
        "middle_name": "ELAINE",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-03-06",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IN",
            "license": "12008739",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Keelie Madison Wagner, APRN, CPNP-PC
• Megan Theresa Wagner
• Monica Wagner
• Patrick A Wagner, PHD
• Samantha Louise Wagner, M.D.
• Whitney Wagner, NP-C
• Yen T Wagner, DDS
• Zachary Cole Wagner, DO
• Daniel Wagoner
• Kiara Nicole Wagoner, LMHC

• General Practice Dentistry in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• General Practice Dentistry in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.