MEDICARE: JON DAGLEY WAGNER MD DDS

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
1	208200000X	Plastic Surgery Physician	95-367	TX
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DD3842	NM
3	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	28634	TX
4	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	055441-1	NY

General Provider Information

NPI Number	:	1154338101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JON DAGLEY WAGNER MD DDS

Provider Business Mailing Address
First Line	:	10000 COORS BYP NW
Second Line	:	SUITE G-218
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4040
Country	:	US
Telephone Number	:	505-242-4867
Fax Number	:

Provider Business Practice Location Address
First Line	:	10000 COORS BYP NW
Second Line	:	SUITE G-218
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87114-4040
Country	:	US
Telephone Number	:	505-242-4867
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2006
Last Update Date	:	04/04/2013

Similar Medicare Providers

1215525902 — AUGUST VOJDANI PA-C
Practice Location Address:

4588 PARADISE BLVD NW , MEDICARE ADVANTAGE CLINIC
ALBUQUERQUE, NM
87114-4105

Practice Phone: 505-998-1840
Practice Fax: 505-998-1841

1578159299 — DANIELLE COHEN LMHC, ATR
Practice Location Address:

10000 COORS BYP NW
ALBUQUERQUE, NM
87114-4040

Practice Phone: 505-677-0988
Practice Fax:

1477530541 — BARRY E SOLOMON DDS
Practice Location Address:

10000 COORS BYP NW , R G 218
ALBUQUERQUE, NM
87114-4040

Practice Phone: 505-242-4867
Practice Fax: 505-890-2883

1952381774 — WILLIAM ASHLEY SAPP DDS
Practice Location Address:

10000 COORS BYP NW , G-218
ALBUQUERQUE, NM
87114-4040

Practice Phone: 505-242-4867
Practice Fax: 505-890-2883

1366592560 — LUXOTTICA RETAIL NORTH AMERICA INC
Practice Location Address:

10000 COORS BYP NW , COTTONWOOD MALL
ALBUQUERQUE, NM
87114-4040

Practice Phone: 505-897-3177
Practice Fax:

1558416719 — LUXOTTICA RETAIL NORTH AMERICA INC
Practice Location Address:

10000 COORS BLVD NW , COTTONWOOD MALL STE #E201
ALBUQUERQUE, NM
87114-4040

Practice Phone: 505-890-6706
Practice Fax:

Directions to “ JON DAGLEY WAGNER MD DDS” 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.