Leslie A Wagner

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D4846 Issued in ID

Practice address

1212 N Cole Rd
Boise, ID 83704-8646

Phone

(208) 901-7451

NPI assigned

Jun 27, 2017

Sex

Female

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)

Not enrolled

State licenses

Practice roles

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.

• Emerald West Family Dentistry

  • Dentist
  • Boise, ID
  • NPI 1639238124
  NPD (past)
• Jason Champagne Idaho 1, PLLC

  • General Practice Dentistry
  • Boise, ID
  • NPI 1558119073
  NPD (past)

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

{
    "created_epoch": "1498521600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1639699036",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4239 E HARDESTY CT",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "83716",
            "telephone_number": "208-869-5139"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1212 N COLE RD",
            "city": "BOISE",
            "state": "ID",
            "postal_code": "837048646",
            "telephone_number": "208-901-7451"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8850 W Emerald St Ste 150",
            "address_purpose": "LOCATION",
            "city": "Boise",
            "state": "ID",
            "postal_code": "837044809",
            "country_code": "US",
            "telephone_number": "208-323-2294",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "LESLIE",
        "middle_name": "A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-27",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ID",
            "license": "D4846",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jocelyn M Waggoner, MD
• April Amber Wagner, PHARMD
• Brandon Mark Wagner, DDS
• Edward C Wagner, DMD
• Lacy Rose Wagner, PA
• Jon Parker Wagnild, MD
• Ashlyn Wahl, PA-C
• Travis Wahl
• Jade Anne Wahnschaffe, PHARMD
• Kennedy Kambo Wainaina, PHARM D

• General Practice Dentistry in Boise, ID
• Providers in Boise, ID by specialty
• General Practice Dentistry in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; 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.