DR. JACOB RYAN WAGNER D.D.S.
NPI 1538017140
Dentist in Crandon, WI

Q: What is Jacob Wagner's NPI number?

The NPI number for Jacob Wagner is 1538017140. It was assigned to this individual provider in the NPPES registry on March 19, 2026.

Q: What is Jacob Wagner's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

Q: When was this NPI record last updated?

The NPPES record for Jacob Wagner was last updated on June 4, 2026. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 2 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since March 19, 2026

8201 MISH KO SWEN DR, CRANDON, WI 54520(608) 206-9268 Get Directions Write a Review

NPPES record last updated: June 4, 2026. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Jun 4, 2026, Mar 19, 2026 (2 updates tracked since 2026).

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About Dr. Jacob Ryan Wagner D.d.s. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. JACOB RYAN WAGNER D.D.S. (NPI 1538017140) is an individual dentist in Crandon, Wisconsin, licensed in Wisconsin (6002171-15) and active in the NPI registry since March 2026.

NPPES Registry Identity

NPI1538017140

Entity TypeIndividualMale

Primary Taxonomy122300000X

Provider Legal NameDR. JACOB RYAN WAGNERCredential: D.D.S.

Location Address8201 MISH KO SWEN DRCrandon, WI 54520-8631

Mailing Address8201 Mish Ko Swen DrCrandon, WI 54520-8631 · (608) 206-9268

Phone(608) 206-9268

Sole ProprietorNo

Enumeration DateMarch 19, 2026

Last NPPES UpdateJune 4, 20262 updates tracked since enumeration

NPPES CertifiedJune 4, 2026

✔ NPI 1538017140 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyDentistDental Providers

Taxonomy Code122300000X

License✔ Licensed in WI · 6002171-15

Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.

8201 MISH KO SWEN DR, Crandon, WI 54520

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