NICHOLAS J WAGNER, DDS, LLC (NPI# 1306231717) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1306231717 |
| Entity Type | Organization |
| Organization Name | NICHOLAS J WAGNER, DDS, LLC |
| Other Organization Name | WARRICK PARK DENTAL |
| Practice Address |
800 Office Park Dr Boonville IN 47601-8601 |
| Practice Telephone | 8128974889 |
| Mailing Telephone | 8128974889 |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2015-04-02 |
| Authorized Official Name | DR. NICHOLAS J WAGNER (DENTIST/OWNER) |
| Authorized Official Telephone | 8128974889 |
| Authorized Official Credential | DDS |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 122300000X | Dentist | 12011465A | IN | Dental Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 1588740815 | 05 | |
| IN | 1023338480 | 05 |
| Other Name | Type Code |
|---|---|
| Warrick Park Dental | Doing Business As Name - Organization |
| Street Address |
800 OFFICE PARK DR |
| City | BOONVILLE |
| State | IN |
| Zip Code | 47601-8601 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1588740815 | Jed Marlin Inman | Dentist | 800 Office Park Dr, Boonville, IN 47601-8601 | 2006-10-30 |
| 1003153354 | Warrick Park Dental | Dentist | 800 Office Park Dr, Boonville, IN 47601-8601 | 2013-01-07 |
| 1023338480 | Nicholas Joseph Wagner | Dentist | 800 Office Park Dr, Boonville, IN 47601-8601 | 2010-06-09 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1235617622 | Dante J Grasso | Dentist | 602 W. Locust St., Boonville, IN 47601 | 2018-07-30 |
| 1053785774 | Michael P Royalty Md LLC | Pain Medicine | 4888 Lost Lake Ct, Boonville, IN 47601 | 2015-11-18 |
| 1982097911 | Doctor James E. Eash, D.d.s., P.C. | Exclusive Provider Organization | 911 Aigner Drive, Boonville, IN 47601 | 2015-03-16 |
| 1073734315 | Warrick County School Corp. | Local Education Agency (LEA) | 300 East Gum Street, Boonville, IN 47601 | 2007-05-02 |
| 1811042237 | St. Marys Warrick Hospital, Inc. | Psychiatric Unit | 1116 Millis Avenue, Boonville, IN 47601 | 2007-01-24 |
| 1073687877 | James E Eash | Dentist | 911 Aigner Dr, Boonville, IN 47601 | 2006-11-20 |
| 1902073554 | Tri-state Behavioral Health LLC | Psychiatry & Neurology | 1116 Millis Ave, St. Mary's Warrick, Boonville, IN 47601 | 2008-05-13 |
| 1073668273 | St. Mary's Warrick Hospital, Inc. | Medicare Defined Swing Bed Unit | 1116 Millis Avenue, Boonville, IN 47601 | 2007-01-25 |
| 1790889046 | Jeffrey P Kolb | Dentist | 602 W Locust St, Boonville, IN 47601-0167 | 2006-09-08 |
| 1376631572 | Kolb & Kolb Dds LLC | Dentist | 602 W Locust St, Boonville, IN 47601-0167 | 2006-10-11 |
| Find all providers in zip 47601 | ||||
| Taxonomy Code | 122300000X |
| Grouping | Dental Providers |
| Classification | Dentist |
| A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992870570 | Richard L Sears Thomas N Caruso Dds PC | Dentist | 3 Schuyler St, Boonville, NY 13309 | 2006-11-21 |
| 1073687877 | James E Eash | Dentist | 911 Aigner Dr, Boonville, IN 47601 | 2006-11-20 |
| 1790889046 | Jeffrey P Kolb | Dentist | 602 W Locust St, Boonville, IN 47601-0167 | 2006-09-08 |
| 1952761819 | Joseph T Kelly, Dds PC | Dentist | 1480 W Ashley Rd, Boonville, MO 65233-2141 | 2016-03-04 |
| 1992122832 | Joseph Thomas Kelly | Dentist | 1480 W Ashley Rd, Boonville, MO 65233-2141 | 2014-03-27 |
| 1023338480 | Nicholas Joseph Wagner | Dentist | 800 Office Park Dr, Boonville, IN 47601-8601 | 2010-06-09 |
| 1134253545 | Richard Louis Sears Jr. | Dentist | 3 Schuyler St, Boonville, NY 13309-1109 | 2007-03-15 |
| 1841324258 | Thomas Nicholas Caruso | Dentist | 3 Schuyler St, Boonville, NY 13309-1109 | 2007-03-15 |
| 1811021876 | Lisa Marie Sears | Dentist | 3 Schuyler St, Boonville, NY 13309-1109 | 2007-03-14 |
| 1780723981 | Toni Marie Mann | Dentist | 13500 Airport Rd, Boonville, CA 95415-9133 | 2007-02-05 |
| Find all providers in BOONVILLE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.