Active NPI
Robert Linton Wagner, DMD
- Dentist
- Flatwoods, KY
National Provider Identifier
1679600944
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- KY4649
- Practice address
- 1402 Argillite Road
Flatwoods, KY 41139 - Phone
- (606) 836-1646
- Fax
- (606) 836-0030
- NPI assigned
- Feb 27, 2007
- Last updated
- Jul 8, 2007
- Sex
- Male
- Sole proprietor
- No
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 | KY4649 | KY | Primary |
Addresses
Primary practice location
1402 Argillite Road
Flatwoods, KY 41139
Mailing address
PO Box 825
1402 Argillite Road
Flatwoods, KY 41139
Phone (606) 836-1646
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 60046497 | Medicaid | KY |
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 |
|---|---|---|---|
| KY4649 | KY | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1172534400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679600944",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 825",
"address_2": "1402 ARGILLITE ROAD",
"city": "FLATWOODS",
"state": "KY",
"postal_code": "41139",
"telephone_number": "606-836-1646",
"fax_number": "606-836-0030"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1402 ARGILLITE ROAD",
"city": "FLATWOODS",
"state": "KY",
"postal_code": "41139",
"telephone_number": "606-836-1646",
"fax_number": "606-836-0030"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "ROBERT",
"middle_name": "LINTON",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-02-27",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "KY",
"license": "KY4649",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "60046497",
"state": "KY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flatwoods, KY
- Stride Prosthetics LLC (Stride Prosthetics)
- Stultz Pharmacy Inc (Stultz Pharmacy)
- Kathy L Summerfield, ARNP
- Seth Larence Thacker, RPH
- Megan Michelle Vernatter, MSN, ARNP,CEN
- Walgreen Co (Walgreens #17727)
- James Anthony Ward, ATC, LAT
- Kathie L Watson-Gray, M.D.
- Whitesville D S Inc (Daniels Pharmacy)
- Robert A Whittaker, D.C.
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.