WAGONER FAMILY DENTAL, PLLC – General Practice Dentistry, NPI 1669245577

WAGONER FAMILY DENTAL, PLLC is a healthcare provider. based in Jenks, Oklahoma. specializing in General Practice Dentistry. The NPI Number for WAGONER FAMILY DENTAL, PLLC is 1669245577

Main info

Organization
Name
WAGONER FAMILY DENTAL, PLLC
NPI
1669245577
Phone
(918) 998-0996
Address
400 RIVERWALK TER STE 250
Authorized Official
LILY DAVIS CREDENTIALING MANAGER
Enumeration Date
2 November 2023
Last Update Date
2 November 2023
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience19
Completeness75
Years active:2State licenses:0Digital endpointsOther names

Provider Addresses for WAGONER FAMILY DENTAL, PLLC

  • 400 RIVERWALK TER STE 250

    JENKS, OK 740375619

    Phone: (918) 998-0996

    Fax: (918) 235-9079

    Type: Mailing

  • 302 S HAYES AVE

    WAGONER, OK 744675551

    Phone: (918) 485-3371

    Type: Location

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

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Medicare Enrollment & Revalidation

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Medicare Utilization (FFS)

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No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 74037)

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Frequently asked questions

Can I cross-check WAGONER FAMILY DENTAL, PLLC using NPI 1669245577?
NPI 1669245577 belongs to WAGONER FAMILY DENTAL, PLLC; compare other details if you need extra assurance.
Would WAGONER FAMILY DENTAL, PLLC appear as active to a payer?
You can treat WAGONER FAMILY DENTAL, PLLC as active for directory purposes; confirm clinical privileges separately.
What area of care is associated with WAGONER FAMILY DENTAL, PLLC?
WAGONER FAMILY DENTAL, PLLC's record emphasizes General Practice Dentistry. Clinical services aligned with this taxonomy classification.
What locale is associated with WAGONER FAMILY DENTAL, PLLC?
Directory geography for WAGONER FAMILY DENTAL, PLLC centers on Jenks, Oklahoma.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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