DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: DR. JACOB RYAN WAGNER D.D.S.

MEDICARE: DR. JACOB RYAN WAGNER D.D.S.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist6002171-15WI

General Provider Information

NPI Number : 1538017140
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JACOB RYAN WAGNER D.D.S.
Provider Business Mailing Address
First Line : 8201 MISH KO SWEN DR
Second Line :
City : CRANDON
State : WI
Zip : 54520-8631
Country : US
Telephone Number : 608-206-9268
Fax Number :
Provider Business Practice Location Address
First Line : 8201 MISH KO SWEN DR
Second Line :
City : CRANDON
State : WI
Zip : 54520-8631
Country : US
Telephone Number : 608-206-9268
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2026
Last Update Date : 06/04/2026

Similar Medicare Providers

1437141579 — RENEE LYNN WALDEN OD
Practice Location Address:
8201 MISH KO SWEN DR
CRANDON, WI
54520-8631
Practice Phone: 715-478-4300
Practice Fax:
1962432658 — BONNIE M SAMUELSON M.D.
Practice Location Address:
8201 MISH KO SWEN DR
CRANDON, WI
54520-8631
Practice Phone: 715-478-4300
Practice Fax:
1285741306 — FOREST COUNTY POTAWATOMI COMMUNITY
Practice Location Address:
8201 MISH KO SWEN DRIVE
CRANDON, WI
54520-8631
Practice Phone: 715-478-4300
Practice Fax: 715-478-4300
1376650499 — FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Practice Location Address:
8201 MISH KO SWEN DR
CRANDON, WI
54520-8631
Practice Phone: 715-478-4300
Practice Fax: 715-478-4490
1407937428 — LISA M ZANT PTA
Practice Location Address:
8201 MISH KO SWEN DR
CRANDON, WI
54520-8631
Practice Phone: 715-478-4300
Practice Fax:
1699856609 — MARGARET GOTHER PT
Practice Location Address:
8201 MISH KO SWEN DR
CRANDON, WI
54520-8631
Practice Phone: 715-478-4300
Practice Fax:

Directions to “ DR. JACOB RYAN WAGNER D.D.S.” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.