Wagoner Family Dental, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WAGONER FAMILY DENTAL, PLLC

Practice address

302 S Hayes Ave
Wagoner, OK 74467-5551

Phone

(918) 485-3371

NPI assigned

Nov 2, 2023

Organization subpart

No

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

Authorized official

Name

Lily Davis

Title

Credentialing Manager

Phone

(918) 998-0996

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Ariel Thorpe, DDS

  • Dentist
  • Wagoner, OK
  • NPI 1205404696
  NPD
• Aaron Harman, D.D.S

  • General Practice Dentistry
  • Wagoner, OK
  • NPI 1710999420
  NPD (past)
• Brandon L Thorpe, DMD

  • Dentist
  • Tulsa, OK
  • NPI 1992373666
  NPD (past)

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

{
    "created_epoch": "1698883200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1698883200000",
    "number": "1669245577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 RIVERWALK TER STE 250",
            "city": "JENKS",
            "state": "OK",
            "postal_code": "740375619",
            "telephone_number": "918-998-0996",
            "fax_number": "918-235-9079"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "302 S HAYES AVE",
            "city": "WAGONER",
            "state": "OK",
            "postal_code": "744675551",
            "telephone_number": "918-485-3371"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WAGONER FAMILY DENTAL, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2023-11-02",
        "last_updated": "2023-11-02",
        "certification_date": "2023-11-02",
        "status": "A",
        "authorized_official_last_name": "DAVIS",
        "authorized_official_first_name": "LILY",
        "authorized_official_title_or_position": "CREDENTIALING MANAGER",
        "authorized_official_telephone_number": "918-998-0996"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Barbara J Volz
• Kristy Lea Vowell, RPH, PHARM.D.
• Wagoner Care Center LLC
• Wagoner Care Center LLC (Wagoner Care Center)
• Wagoner Eye Clinic Inc
• Wagoner Family Dentistry, PC
• Wagoner Health & Rehab LLC (Wagoner Health & Rehab)
• Wagoner Hospital Authority
• Wagoner Hospital Authority
• Wagoner Hospital Authority (Wagoner Hospital Authority dba Wagoner Community Hospital)

• General Practice Dentistry in Wagoner, OK
• Providers in Wagoner, OK by specialty
• General Practice Dentistry in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2023; 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.