David Alan Wagner, D.D.S.

Primary specialty

ProsthodonticsTaxonomy code 1223P0700X

License

2901020879 Issued in MI

Practice address

500 N Leroy St
Fenton, MI 48430-2734

Phone

(810) 629-8272

Fax

(810) 629-3218

NPI assigned

Feb 11, 2013

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Big Rapids Family Dental PLC

  • General Practice Dentistry
  • Big Rapids, MI
  • NPI 1376230979
  NPD
• Alex T Gould DMD PLC

  • General Practice Dentistry
  • Reed City, MI
  • NPI 1265064976
  NPD (past)

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

{
    "created_epoch": "1360540800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1436832000000",
    "number": "1841539905",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201S MICHIGAN AVE",
            "city": "BIG RAPIDS",
            "state": "MI",
            "postal_code": "493071809",
            "telephone_number": "231-796-4747",
            "fax_number": "231-796-5711"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "500 N LEROY ST",
            "city": "FENTON",
            "state": "MI",
            "postal_code": "484302734",
            "telephone_number": "810-629-8272",
            "fax_number": "810-629-3218"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "DAVID",
        "middle_name": "ALAN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-02-11",
        "last_updated": "2015-07-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "PA",
            "license": "DS038617",
            "primary": false
        },
        {
            "code": "1223P0700X",
            "taxonomy_group": "",
            "desc": "Dentist, Prosthodontics",
            "state": "MI",
            "license": "2901020879",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• VG's Pharmacy Inc (VG's Pharmacy #1)
• VG's Pharmacy, Inc (VG's Pharmacy #15)
• Kellie Marie Vile, PHARMD
• Jacqui Lorraine Wade, RN., BSN
• Andrea Wagner, NP
• Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2693)
• Wal-Mart Stores East, LP (Vision Center 30-2693)
• Walgreen Co (Walgreens# 07065)
• Walsh Chiropractic & Wellness Center LLC
• Michael Thomas Walsh, D.C.

• Prosthodontics in Fenton, MI
• Providers in Fenton, MI by specialty
• Prosthodontics in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2015; 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.