William Scott Wagner, D.M.D., P.A.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN14961 Issued in FL

Practice address

1400 Marsh Landing Pkwy
Suite 104
Jacksonville Beach, FL 32250-2493

Phone

(904) 834-3737

Fax

(904) 758-0545

NPI assigned

Jan 18, 2007

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

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

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 and National Provider Directory roles.

• Eccella Smiles PA

  • General Practice Dentistry
  • Jacksonville Beach, FL
  • NPI 1568852010
  NPD (past) Authorized official

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

{
    "created_epoch": "1169078400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1395964800000",
    "number": "1760535587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1400 MARSH LANDING PKWY",
            "address_2": "SUITE 104",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502493",
            "telephone_number": "904-834-3737",
            "fax_number": "904-758-0545"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1400 MARSH LANDING PKWY",
            "address_2": "SUITE 104",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322502493",
            "telephone_number": "904-834-3737",
            "fax_number": "904-758-0545"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "WILLIAM",
        "middle_name": "SCOTT",
        "name_prefix": "Dr.",
        "credential": "D.M.D., P.A.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-18",
        "last_updated": "2014-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN14961",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Erin Vinski, LCSW
• Johanna Coutinho Vogt, MS, RDN, LD
• Ann Vonthron, M.D.
• Milton John Vonthron, M.D.
• Vori Medical PLLC
• Shabnam Wahid, PHARMD
• William Wainwright, MD
• Wal-Mart Stores East, LP
• Jessica Hope Walczak, PT, DPT
• Walgreen Co

• General Practice Dentistry in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 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.

Verify at the official NPI Registry.