Chad L Wagstaff, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

019-025276 Issued in IL

Practice address

2640 N Highway 162
Eden, UT 84310-9745

Phone

(801) 745-1100

NPI assigned

Mar 13, 2007

Last updated

Nov 6, 2014By the provider in NPPES

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 UT

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

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• CLW DDS PLLC

  • Dentist
  • Eden, UT
  • NPI 1871626630
  NPD (past) Authorized official

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

{
    "created_epoch": "1173744000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1415232000000",
    "number": "1730212564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 805",
            "address_2": "2640 N HIGHWAY 162",
            "city": "EDEN",
            "state": "UT",
            "postal_code": "843100805"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2640 N HIGHWAY 162",
            "city": "EDEN",
            "state": "UT",
            "postal_code": "843109745",
            "telephone_number": "801-745-1100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGSTAFF",
        "first_name": "CHAD",
        "middle_name": "L",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-13",
        "last_updated": "2014-11-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "IL",
            "license": "019-025276",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry Lynn Spainhower, PHARMD
• Spirit Mountain Recovery, Inc.
• Valley Care Clinic
• Valley Family Medical
• Valley Physical Therapy PLLC (Valley PT)
• Wildflower Mountain Ranch Inc

• General Practice Dentistry in Eden, UT
• Providers in Eden, UT by specialty
• General Practice Dentistry in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 6, 2014; 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.