Bryan L Wagner, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

30.025923 Issued in OH

Practice address

8300 Hough Ave
Cleveland, OH 44103-4247

Phone

(216) 231-7700

Fax

(216) 231-7920

NPI assigned

Jul 19, 2019

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

Enrolled in OH

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

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: bryan.wagner.p1@direct.neon.nextgenshare.com

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.

• Northeast Ohio Neighborhood Health Services, Inc.

  • Federally Qualified Health Center (FQHC)
  • Cleveland, OH
  • NPI 1851302665
  Medicare reassignment NPD
• Wagner Dental

  • Dental Clinic/Center
  • Garrettsville, OH
  • NPI 1386492239
  NPD Authorized official
• Northeast Ohio Neighborhood Health Services, Inc.

  • Primary Care Clinic/Center
  • Cleveland, OH
  • NPI 1922112960
  NPD

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

{
    "created_epoch": "1563494400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1563494400000",
    "number": "1629621545",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4800 PAYNE AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441032443",
            "telephone_number": "216-231-7700",
            "fax_number": "216-231-3828"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8300 HOUGH AVE",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "441034247",
            "telephone_number": "216-231-7700",
            "fax_number": "216-231-7920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "BRYAN",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-07-19",
        "last_updated": "2019-07-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "30.025923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pratik Wagle, DO
• Amanda Wagner
• Andrew Wagner, PT, DPT
• Ariana Shanel Wagner
• Ashli Wagner, PA-C
• Debra A Wagner, RN
• Diamon Wagner, STNA
• Elizabeth I Wagner, QMHS
• John L. Wagner, M.D.
• Karl G Wagner, MD

• General Practice Dentistry in Cleveland, OH
• Providers in Cleveland, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 19, 2019; 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.