Provider Demographics
NPI:1639341456
Name:BRIAN J WAGGLE DDS INC
Entity Type:Organization
Organization Name:BRIAN J WAGGLE DDS INC
Other - Org Name:NORTHPOINTE DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WAGGLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:740-454-6644
Mailing Address - Street 1:4063 NORTHPOINTE DRIVE
Mailing Address - Street 2:
Mailing Address - City:ZANESVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43701
Mailing Address - Country:US
Mailing Address - Phone:740-454-6644
Mailing Address - Fax:740-588-0950
Practice Address - Street 1:4063 NORTHPOINTE DRIVE
Practice Address - Street 2:
Practice Address - City:ZANESVILLE
Practice Address - State:OH
Practice Address - Zip Code:43701
Practice Address - Country:US
Practice Address - Phone:740-454-6644
Practice Address - Fax:740-588-0950
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2008-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0168214Medicaid