Eric James Wagoner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

9367 Issued in NC

Practice address

835 Wake Forest Business Park Ste E
Wake Forest, NC 27587-7324

Phone

(919) 570-7930

NPI assigned

Oct 4, 2012

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in NC

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

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

{
    "created_epoch": "1349308800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1750633483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "835 WAKE FOREST BUSINESS PARK STE E",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877324",
            "telephone_number": "919-570-7930"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "835 WAKE FOREST BUSINESS PARK STE E",
            "city": "WAKE FOREST",
            "state": "NC",
            "postal_code": "275877324",
            "telephone_number": "919-570-7930"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "ERIC",
        "middle_name": "JAMES",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-10-04",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "9367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5921749",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• W E B Dubois CDC
• W.E.B. Dubois Community Development Corporation
• Charles Wade
• Joanne E Wagner, MD
• Wagoner Holdings PA (Wake Forest Chiropractic)
• Evan Jonathon Wagoner, DC
• Androu Wahba, DPT
• Wake Audiology & Hearing Aid Associates, PLLC
• Wake County Psychological Services, Inc.
• Wake Family Chiropractic PA

• General Practice Dentistry in Wake Forest, NC
• Providers in Wake Forest, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; 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.