DR. BRADLEY DUANE WAGONER DDS NPI 1225019201

NPI Information

  • NPI: 1225019201
  • Provider Name: DR. BRADLEY DUANE WAGONER, DDS
  • Classification: Dentist - 1223G0001X
  • Specialization: General Practice
  • Entity Type: Individual
  • Address: 955 31ST ST
    MARION, IA
    ZIP 52302
  • Phone: (319) 377-4867

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NPI Details

DR. Bradley Duane Wagoner, DDS is a general practice dentist in Marion, IA. The provider is a general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs. DR. Bradley Duane Wagoner, DDS NPI is 1225019201. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

955 31ST ST
MARION, IA
ZIP 52302-788
Phone: (319) 377-4867
Fax: (319) 377-4383

The enumeration date for this NPI number is 11/8/2005 and was last updated on 7/9/2007.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223G0001XDentistGeneral Practice6894IOWAYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
10207225MEDICAIDIOWA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 3/30/2025

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