Healthcare Provider Details

I. General information

NPI: 1326239302
Provider Name (Legal Business Name): CARY DANIEL WAGNER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 NORTH ST
NEWBURGH NY
12550-3143
US

IV. Provider business mailing address

275 NORTH ST
NEWBURGH NY
12550-3143
US

V. Phone/Fax

Practice location:
  • Phone: 845-561-2494
  • Fax: 845-561-0681
Mailing address:
  • Phone: 845-561-2494
  • Fax: 845-561-0681

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number053556-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: