Active NPI
Joseph Leo Waldvogel, D.D.S.
- General Practice Dentistry
- Poplar Bluff, MO
National Provider Identifier
1871780262
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 019-016659
- Practice address
- 1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318 - Phone
- (573) 686-4151
- NPI assigned
- Sep 28, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 019-016659 | IL | Primary |
Addresses
Primary practice location
1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318
Mailing address
1500 N Westwood Blvd
Poplar Bluff, MO 63901-3318
Phone (573) 686-4151
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 12 | Other | IL | DENTAL PROVIDER |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 019-016659 | IL | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190937600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1442448000000",
"number": "1871780262",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1500 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013318",
"telephone_number": "573-686-4151"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1500 N WESTWOOD BLVD",
"city": "POPLAR BLUFF",
"state": "MO",
"postal_code": "639013318",
"telephone_number": "573-686-4151"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALDVOGEL",
"first_name": "JOSEPH",
"middle_name": "LEO",
"name_prefix": "Dr.",
"credential": "D.D.S.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-28",
"last_updated": "2015-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "IL",
"license": "019-016659",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTAL PROVIDER",
"identifier": "12",
"state": "IL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Poplar Bluff, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 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.