Active NPI
Mark Bennett Waggoner, DDS
- General Practice Dentistry
- Plano, TX
National Provider Identifier
1720107717
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 13820
- Practice address
- 3104 Harvard CT
Plano, TX 75093-3450 - Phone
- (972) 333-6204
- NPI assigned
- Mar 29, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 13820 | TX | Primary |
| Dental Anesthesiology | 1223D0004X | 13820 | TX |
Addresses
Primary practice location
3104 Harvard CT
Plano, TX 75093-3450
Mailing address
3104 Harvard CT
Plano, TX 75093-3450
Phone (972) 333-6204
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 13820 | TX | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1175126400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1414022400000",
"number": "1720107717",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3104 HARVARD CT",
"city": "PLANO",
"state": "TX",
"postal_code": "750933450",
"telephone_number": "972-333-6204"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3104 HARVARD CT",
"city": "PLANO",
"state": "TX",
"postal_code": "750933450",
"telephone_number": "972-333-6204"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "MARK",
"middle_name": "BENNETT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-03-29",
"last_updated": "2014-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "TX",
"license": "13820",
"primary": true
},
{
"code": "1223D0004X",
"taxonomy_group": "",
"desc": "Dentist, Dental Anesthesiology",
"state": "TX",
"license": "13820",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Plano, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.