| Dr Neilson Lane Wagley, DMD | |
|
5437 Mahoning Ave, Austintown, OH 44515-2437 | |
| (330) 792-2501 | |
| Not Available |
| Full Name | Dr Neilson Lane Wagley |
|---|---|
| Gender | Male |
| Speciality | Maxillofacial Surgery |
| Experience | 7 Years |
| Location | 5437 Mahoning Ave, Austintown, Ohio |
| Accepts Medicare Assignments | Yes. He accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427582964 | NPI | - | NPPES |
| 11222 | Other | TN | STATE DENTAL LICENSE |
| 30.026403 | Other | OH | STATE DENTAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 11222 (Tennessee) | Secondary |
| 1223S0112X | Dentist - Oral And Maxillofacial Surgery | 30.026403 (Ohio) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| St Elizabeth Youngstown Hospital | Youngstown, OH | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| Mill Creek Oral And Maxillofacial Surgery Associates Inc | 8325205206 | 3 |
| Entity Name | Mill Creek Oral & Maxillofacial Surgery Associates Inc |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1063549236 PECOS PAC ID: 8325205206 Enrollment ID: O20120203000559 |
| Mailing Address | Practice Location Address |
|---|---|
| Dr Neilson Lane Wagley, DMD 5437 Mahoning Ave, Austintown, OH 44515-2437 Ph: (330) 792-2501 | Dr Neilson Lane Wagley, DMD 5437 Mahoning Ave, Austintown, OH 44515-2437 Ph: (330) 792-2501 |
Dr. Jennifer L Gerbasi, DDS Dentist Medicare: Medicare Enrolled Practice Location: 5600 Mahoning Ave, Austintown, OH 44515 Phone: 330-318-3150 | |
Dr. Dominic Joseph Pannunzio, DDS Dentist Medicare: Not Enrolled in Medicare Practice Location: 290 S Canfield-niles Rd, Suite A, Austintown, OH 44515 Phone: 330-797-0246 | |
Edward William Kubic Jr., D.D.S. Dentist Medicare: Not Enrolled in Medicare Practice Location: 1050 S Canfield Niles Rd, Austintown, OH 44515 Phone: 330-799-1453 | |
Philip A Leone, DDS Dentist Medicare: Medicare Enrolled Practice Location: 5669 Mahoning Avenue, Suite A, Austintown, OH 44515 Phone: 330-792-2749 Fax: 330-792-1128 | |
Dr. Varun Kalra, DDS MS Dentist Medicare: Not Enrolled in Medicare Practice Location: 25 N Canfield Niles Road, Suite 108, Austintown, OH 44515 Phone: 330-792-3888 Fax: 330-792-0794 | |
Dr. Rachel Doan, DDS Dentist Medicare: Medicare Enrolled Practice Location: 5669 Mahoning Ave Ste A, Austintown, OH 44515 Phone: 330-792-2749 Fax: 330-792-1128 |