Katie-Rose Radin Wagner, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

DN1855704 Issued in MA

Practice address

6 Kensington Ave
Somerville, MA 02145-2107

Phone

(617) 623-2100

NPI assigned

Jul 1, 2010

Sex

Female

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 MA

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

Practice roles

Locations

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.

• Smiles by Rosie Vaccination Clinic

  • General Practice Physician
  • Somerville, MA
  • NPI 1831022417
  NPD Authorized official
• Smiles by Rosie, Inc.

  • General Practice Dentistry
  • Somerville, MA
  • NPI 1326304841
  NPD (past) Authorized official

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

{
    "created_epoch": "1277942400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1760793087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6 KENSINGTON AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021452107",
            "telephone_number": "617-623-2100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6 KENSINGTON AVE",
            "city": "SOMERVILLE",
            "state": "MA",
            "postal_code": "021452107",
            "telephone_number": "617-623-2100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KATIE-ROSE",
        "middle_name": "RADIN",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2010-07-01",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MA",
            "license": "DN1855704",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "110067489A",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Kate Stacey Vital
• Rachel B Vogel, M.D.
• Lydia Volaitis
• Danielle Volmar
• Andrea Joan Wagner, M.D.
• Hafsa Wahid
• Nicolette M Waite, RN, BSN
• Walgreen Co
• Walgreen Co
• Walgreen Co

• Dentist in Somerville, MA
• Providers in Somerville, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; 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.