Active NPI
Ross O. Wagstaff
- Dentist
- Wilmington, OH
National Provider Identifier
1598053605
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 30-023499
- Practice address
- 150 N South St
Wilmington, OH 45177-1647 - Phone
- (937) 382-2041
- NPI assigned
- Jul 11, 2011
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 30-023499 | OH | Primary |
Addresses
Primary practice location
150 N South St
Wilmington, OH 45177-1647
Mailing address
150 N South St
Wilmington, OH 45177-1647
Phone (937) 382-2041
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 30-023499 | Other | OH | DENTAL LICENSE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 30-023499 | OH | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1310342400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1310342400000",
"number": "1598053605",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "150 N SOUTH ST",
"city": "WILMINGTON",
"state": "OH",
"postal_code": "451771647",
"telephone_number": "937-382-2041"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "150 N SOUTH ST",
"city": "WILMINGTON",
"state": "OH",
"postal_code": "451771647",
"telephone_number": "937-382-2041"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGSTAFF",
"first_name": "ROSS",
"middle_name": "O.",
"name_prefix": "Dr.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2011-07-11",
"last_updated": "2011-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "OH",
"license": "30-023499",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL LICENSE",
"identifier": "30-023499",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wilmington, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.