NPIMap

Organization Active NPI

Melinda L. Wagner DMD LLC

  • General Practice Dentistry
  • Red Bank, NJ
National Provider Identifier
1891085569
Registry record updated Apr 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
14142 Issued in NJ
Legal business name
MELINDA L. WAGNER DMD LLC
Practice address
191 Broad St.
Red Bank, NJ 07701
Phone
(732) 747-2022
Fax
(732) 747-5524
NPI assigned
Apr 14, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 14, 2011

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

Authorized official

Name
Melinda L. Wagner, DMDNPI 1609049907
Title
Owner
Phone
(732) 747-2022

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 14142 NJ Primary

Addresses

Primary practice location

191 Broad St.
Red Bank, NJ 07701

Mailing address

191 Broad St.
Red Bank, NJ 07701
Phone (732) 747-2022

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1302739200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1302739200000",
    "number": "1891085569",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "191 BROAD ST.",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "07701",
            "telephone_number": "732-747-2022",
            "fax_number": "732-747-5524"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "191 BROAD ST.",
            "city": "RED BANK",
            "state": "NJ",
            "postal_code": "07701",
            "telephone_number": "732-747-2022",
            "fax_number": "732-747-5524"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MELINDA L. WAGNER DMD LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-14",
        "last_updated": "2011-04-14",
        "status": "A",
        "authorized_official_last_name": "WAGNER",
        "authorized_official_first_name": "MELINDA",
        "authorized_official_middle_name": "L.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "732-747-2022",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "NJ",
            "license": "14142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Red Bank, NJ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2011; 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.