Active NPI
Lisa Ann Wagner, DMD
- Dentist
- Alpharetta, GA
National Provider Identifier
1982776712
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- DN010372
- Practice address
- 1130 Sanctuary Pkwy
Alpharetta, GA 30009-4839 - Phone
- (770) 641-5168
- NPI assigned
- Nov 15, 2006
- Last updated
- Sep 20, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | DN010372 | GA | Primary |
Addresses
Primary practice location
1130 Sanctuary Pkwy
Alpharetta, GA 30009-4839
Mailing address
425 Paris Drive
Lawrenceville, GA 30043-6144
Phone (770) 399-1582
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in GA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20161003001594 | GA | Order and Referring Only - Oral Surgery | 5294022463 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| DN010372 | GA | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1163548800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1474329600000",
"number": "1982776712",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "425 PARIS DRIVE",
"city": "LAWRENCEVILLE",
"state": "GA",
"postal_code": "300436144",
"telephone_number": "770-399-1582"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 SANCTUARY PKWY",
"city": "ALPHARETTA",
"state": "GA",
"postal_code": "300094839",
"telephone_number": "770-641-5168"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGNER",
"first_name": "LISA",
"middle_name": "ANN",
"credential": "DMD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-11-15",
"last_updated": "2016-09-20",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "GA",
"license": "DN010372",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alpharetta, GA
- Lisa Wade, MS, OTR/L
- Mary L Wade, RN
- Lauren Elizabeth Wager, DDS
- Amy R Wagner, ED.D., LCSW, BCABA
- Cara Wagner
- Wal-Mart Stores East LP (Wal-Mart Pharmacy 10-2941)
- Wal-Mart Stores East LP (Walmart Pharmacy 10-4436)
- Wal-Mart Stores East, LP (Walmart Vision Center 30-4436)
- Wal-Mart Stores East, LP (Vision Center 30-2941)
- Walgreen Co (Walgreens #05760)
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.