DR. JIM A WAGNER (NPI# 1508013210) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1508013210 |
| Entity Type | Individual |
| Full Name | DR. JIM A WAGNER |
| Credential | DDS, MS |
| Practice Address |
2605 Browns Ln Jonesboro AR 72401 |
| Mailing Address |
2605 Browns Ln Jonesboro AR 72401-7227 |
| Practice Telephone | 8709725445 |
| Practice Fax Number | 8709720852 |
| Mailing Telephone | 8709725445 |
| Mailing Fax Number | 8709720852 |
| Enumeration Date | 2008-08-25 |
| Last Update Date | 2008-08-25 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223X0400X |
Dentist Specialization: Orthodontics and Dentofacial Orthopedics |
2138 | AR | Dental Providers |
| Street Address |
2605 BROWNS LN |
| City | JONESBORO |
| State | AR |
| Zip Code | 72401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1942471271 | Kolin Emrys Weaver | Dentist | 2605 Browns Ln, Jonesboro, AR 72401-7227 | 2008-03-14 |
| 1932756608 | Savanah L Stewart | Dentist | 2605 Browns Ln, Jonesboro, AR 72401-7227 | 2019-08-19 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1407453368 | Mariah Kay Jackson | Physical Therapy Assistant | Creative Kids Therapy, Jonesboro, AR 72401 | 2020-10-05 |
| 1821606005 | Kafayat Folake Iyanda | Specialist/Technologist | 2105 East Aggie Rd, Jonesboro, AR 72401 | 2020-07-14 |
| 1053936310 | Josh Roberts | Physical Therapist | 1010 South Main St, Jonesboro, AR 72401 | 2020-06-12 |
| 1003449687 | Amy Mary Elizabeth Daughhetee | Nurse Practitioner | 225 East Washington Ave, Jonesboro, AR 72401 | 2020-02-21 |
| 1871126698 | Sarah Lowtharp | Clinical Nurse Specialist | 225 East Washington Ave., Jonesboro, AR 72401 | 2020-02-20 |
| 1891335519 | Mallori Miller | Case Manager/Care Coordinator | 837 Willett Rd, Jonesboro, AR 72401 | 2020-01-10 |
| 1265073704 | Michael Bruce Collie | Registered Nurse | 837 Williett Road, Jonesboro, AR 72401 | 2019-10-07 |
| 1285283432 | Jonesboro Ambulatory Surgery Center, LLC | Clinic/Center | 1710 Mayfield Dr, Jonesboro, AR 72401 | 2019-09-10 |
| 1841843943 | Destinee Katrina Cole | Specialist/Technologist | 2015 Aggie Rd, Jonesboro, AR 72401 | 2019-07-18 |
| 1699250472 | Jessica Marie Mcnatt | Occupational Therapist | 907 County Road 753, Jonesboro, AR 72401 | 2018-09-27 |
| Find all providers in zip 72401 | ||||
| Taxonomy Code | 1223X0400X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Orthodontics and Dentofacial Orthopedics |
| That area of dentistry concerned with the supervision, guidance and correction of the growing or mature dentofacial structures, including those conditions that require movement of teeth or correction of malrelationships and malformations of their related structures and the adjustment of relationships between and among teeth and facial bones by the application of forces and/or the stimulation and redirection of functional forces within the craniofacial complex. Major responsibilities of orthodontic practice include the diagnosis, prevention, interception and treatment of all forms of malocclusion of the teeth and associated alterations in their surrounding structures; the design, application and control of functional and corrective appliances; and the guidance of the dentition and its supporting structures to attain and maintain optimum occlusal relations in physiologic and esthetic harmony among facial and cranial structures. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1982229985 | Kolin E. Weaver, Dds, Ms, Inc. | Dentist | 2316 Red Wolf Blvd Ste C, Jonesboro, AR 72401-6360 | 2020-06-15 |
| 1043681448 | Axpm Jonesboro, Pllc | Dentist | 2316 Red Wolf Blvd, Suite C, Jonesboro, AR 72401-0000 | 2015-10-12 |
| 1700290194 | Bethel Burris Oliver Pllc | Dentist | 4803 E Johnson Ave, Jonesboro, AR 72401-8413 | 2014-06-13 |
| 1003194317 | Fergus Orthodontics Pllc | Dentist | 801 Osler Drive, Suite D, Jonesboro, AR 72401 | 2011-08-03 |
| 1457649220 | Bufford Suffridge | Dentist | 2606 Browns Ln, Jonesboro, AR 72401-7226 | 2011-07-14 |
| 1093979254 | Kelly-gwynne Mason Fergus | Dentist | 2812 Harrisburg Rd, Jonesboro, AR 72401-6081 | 2008-07-16 |
| 1942471271 | Kolin Emrys Weaver | Dentist | 2605 Browns Ln, Jonesboro, AR 72401-7227 | 2008-03-14 |
| 1184727315 | T Scott Allen Dds Ms | Dentist | 910 Professional Acres Dr, Jonesboro, AR 72401-4321 | 2006-09-06 |
| 1932756608 | Savanah L Stewart | Dentist | 2605 Browns Ln, Jonesboro, AR 72401-7227 | 2019-08-19 |
| 1285049288 | John Stephen Boling | Dentist | 2606 Browns Ln, Jonesboro, AR 72401-7226 | 2014-06-27 |
| Find all providers in JONESBORO | ||||
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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.