Joel M Wagoner, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

4126 Issued in NC

Practice address

77 Vilcom Center Dr
Suite 110
Chapel Hill, NC 27514-1598

Phone

(919) 968-9697

Fax

(919) 942-3331

NPI assigned

May 24, 2005

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

Other identifiers 4

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": "1116892800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1291852800000",
    "number": "1982607826",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "77 VILCOM CENTER DR",
            "address_2": "SUITE 110",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275141598",
            "telephone_number": "919-968-9697",
            "fax_number": "919-942-3331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "77 VILCOM CENTER DR",
            "address_2": "SUITE 110",
            "city": "CHAPEL HILL",
            "state": "NC",
            "postal_code": "275141598",
            "telephone_number": "919-968-9697",
            "fax_number": "919-942-3331"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WAGONER",
        "first_name": "JOEL",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-05-24",
        "last_updated": "2010-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "NC",
            "license": "4126",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI",
            "identifier": "535847",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBSNC",
            "identifier": "9015X",
            "state": "NC"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "899015X",
            "state": "NC"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BC",
            "identifier": "464231",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Richard W Wagner Jr., DMD
• Sandra M Wagner, PA-C
• Shaun R. Wagner, D.O.
• Sibyl Maureen Wagner, MSW, LCSW
• Andrew Johnston Wagoner, D.D.S
• Karlee Crumpton Wagoner, APRN-BC
• Alexandria Nicole Wagstaff, PA-C
• Kelly Marie Waicus, MD
• Justin David Wain, DO
• Wake Specialty Physicians LLC

• General Practice Dentistry in Chapel Hill, NC
• Providers in Chapel Hill, NC by specialty
• General Practice Dentistry in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 9, 2010; 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.