Robert Michael Wagner Jr., D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN18337 Issued in FL

Practice address

650 NW 180TH Ter
Suite 103
Pembroke Pines, FL 33029-2825

Phone

(954) 437-9288

Fax

(954) 437-7929

NPI assigned

Oct 7, 2008

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

State licenses

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

{
    "created_epoch": "1223337600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1223337600000",
    "number": "1861643967",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "650 NW 180TH TERRACE",
            "address_2": "SUITE 103",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292825",
            "telephone_number": "954-437-9288",
            "fax_number": "954-437-7929"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 NW 180TH TER",
            "address_2": "SUITE 103",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330292825",
            "telephone_number": "954-437-9288",
            "fax_number": "954-437-7929"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "ROBERT",
        "middle_name": "MICHAEL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-10-07",
        "last_updated": "2008-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN18337",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patricia Wade-Gibbs, M.D.
• Julene Wade
• Trameka Wade
• Ashna Wadhawan, MD
• Aaron Michael Wagner, MD
• Shekiah Wagner
• Hayley Waisome
• Wal-Mart Stores East LP (WalMart Pharmacy 10-5932)
• Wal-Mart Stores East LP (Walmart Pharmacy 10-2591)
• Wal-Mart Stores East, LP (Vision Center 30-2591)

• General Practice Dentistry in Pembroke Pines, FL
• Providers in Pembroke Pines, 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 Oct 7, 2008; 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.