1043470214 NPI number — DR. RICHARD W WAGNER JR. DMD

Table of content: DR. RICHARD W WAGNER JR. DMD (NPI 1043470214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043470214 NPI number — DR. RICHARD W WAGNER JR. DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WAGNER
Provider First Name:
RICHARD
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1043470214
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
123 W FRANKLIN ST
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
CHAPEL HILL
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27516-2524
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-967-9291
Provider Business Mailing Address Fax Number:
919-942-4446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
123 W FRANKLIN ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
CHAPEL HILL
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27516-2524
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-967-9291
Provider Business Practice Location Address Fax Number:
919-942-4446
Provider Enumeration Date:
06/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  7701 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 098741004 . This is a "ADA" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com