Spencer B Wagner, D.M.D

Primary specialty

DentistTaxonomy code 122300000X

License

3192 Issued in SC

Practice address

2520 N University Ave
Suite 101
Provo, UT 84604-3804

Phone

(801) 426-6255

Fax

(801) 224-2966

NPI assigned

Feb 25, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in SC

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": "1203897600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1357257600000",
    "number": "1578732467",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2520 N UNIVERSITY AVE",
            "address_2": "SUITE 101",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043804",
            "telephone_number": "801-426-6255",
            "fax_number": "801-224-2966"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2520 N UNIVERSITY AVE",
            "address_2": "SUITE 101",
            "city": "PROVO",
            "state": "UT",
            "postal_code": "846043804",
            "telephone_number": "801-426-6255",
            "fax_number": "801-224-2966"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "SPENCER",
        "middle_name": "B",
        "name_prefix": "Dr.",
        "credential": "D.M.D",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-02-25",
        "last_updated": "2013-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "SC",
            "license": "3192",
            "primary": true
        },
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "UT",
            "license": "6026130",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "Z31920",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Amanda Vuniwai
• W Reid Cluff OD PLLC
• Matthew David Wagaman, MD
• Cathe J Wagner
• Gabriel Catherine Wagner
• Autumn Rose Wahl, IBCLC
• Megan Marie Waite
• Sarah Marie Waite
• Whittney Wakefield
• Taylor Walch

• Dentist in Provo, UT
• Providers in Provo, UT by specialty
• Dentist in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2013; 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.