Richard Bruce Wagner, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

05978 Issued in IA

Practice address

346 Dental Science S
Iowa City, IA 52242-1001

Phone

(319) 335-9656

NPI assigned

Jun 21, 2006

Sex

Male

Sole proprietor

No

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

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375660800000",
    "number": "1629014485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "322 DENTAL SCIENCE S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-384-1139",
            "fax_number": "319-384-1775"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "346 DENTAL SCIENCE S",
            "city": "IOWA CITY",
            "state": "IA",
            "postal_code": "522421001",
            "telephone_number": "319-335-9656"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "RICHARD",
        "middle_name": "BRUCE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-21",
        "last_updated": "2013-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IA",
            "license": "05978",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Paige Elizabeth Wageman
• Amber Jean Waggoner, RN
• Allison Nicole Wagner, M.D.
• Conrad Alexander Wagner, PHARMD
• Kelly Wagner, MS, RD, LD
• Vincent M Wagner, M.D.
• Michael Dean Wagoner, MD
• Amr Tarek Wahba
• Terry Lynn Wahls, MD
• Wal-Mart Stores, Inc. (Vision Center 30-1721)

• General Practice Dentistry in Iowa City, IA
• Providers in Iowa City, IA by specialty
• General Practice Dentistry in Iowa

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 2013; 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.