Stephanie Ann Wagner Kethcart, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D6695 Issued in AZ

Practice address

1277 E Missouri Ave Ste 102
Phoenix, AZ 85014-2916

Phone

(602) 812-4326

Fax

(602) 883-7252

NPI assigned

Jul 6, 2006

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

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.

• Kethcart Smiles PLLC

  • General Practice Dentistry
  • Phoenix, AZ
  • NPI 1245680438
  NPD

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

{
    "created_epoch": "1152144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565395200000",
    "number": "1508897406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1277 E MISSOURI AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142916",
            "telephone_number": "602-615-8516",
            "fax_number": "602-883-7252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1277 E MISSOURI AVE STE 102",
            "city": "PHOENIX",
            "state": "AZ",
            "postal_code": "850142916",
            "telephone_number": "602-812-4326",
            "fax_number": "602-883-7252"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER KETHCART",
        "first_name": "STEPHANIE",
        "middle_name": "ANN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-06",
        "last_updated": "2019-08-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "AZ",
            "license": "D6695",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Mark Wager
• Kristi Wagers
• Reina Marcela Waggener, RDH
• Jennifer Waggoner, PTA
• Candi Virginia Wagman, RN
• Adam Brian Wagner, D.C.
• Alexandria Wagner, BCBA
• Brittany Wagner
• Brittney Wagner, BCBA
• Deanna Wagner, SLP

• General Practice Dentistry in Phoenix, AZ
• Providers in Phoenix, AZ by specialty
• General Practice Dentistry in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 10, 2019; 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.