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Deactivated NPI 1508939018 Deactivated / Inactive NPI Male Practitioner

Dr. Russell Kent Wangen , DMD

Dentist - General Practice • Pawnee, IL

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Dr. Russell Wangen has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date November 15, 2006
NPI Deactivation Date November 29, 2023
Total Practice Duration ~17 Years of Practice (2006 – 2023)

Professional Overview & Biography Verified Profile Summary

Dr. Russell Wangen, DMD was a registered Dentist - General Practice practicing in Pawnee, IL. Throughout an active medical career spanning 17 years, Dr. Wangen provided care at the practice location at 1105 CARROLL ST. until profile deactivation on 2023-11-29.

Practice Location & Contact Primary Location

Practice Address

1105 Carroll St.

Pawnee, IL 65558

Telephone 2176257953
Fax 2176257953

Specialty Benchmarks & Practice Insights

Comparative analytics for Dentist - General Practice in Pawnee, IL

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 10.5 Yrs
State Avg: 18.0 Yrs
Regional Practice Density
1 Specialists

Practicing in Pawnee, IL (5581 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

Dentist - General Practice Primary Specialty

NUCC Taxonomy Code: 1223G0001X

State License IL 1915698

A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

7 Historical Events
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NPI Profile Deactivated November 29, 2023

Record deactivated on November 29, 2023

NPI Profile Active July 08, 2007

NPI status registered as active in NPPES database

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Updated Practice Location July 08, 2007

Registered at 1105 CARROLL ST., PAWNEE, IL 65558 (Tel: 2176257953)

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Updated Business Mailing Address July 08, 2007

Registered at 1105 CARROLL ST., PO BOX 860, PAWNEE, IL 65558 (Tel: 2176257953)

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Provider Name / Credentials Updated July 08, 2007

Recorded as RUSSELL WANGEN, DMD

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Medical Taxonomy / Specialty Registered (Primary Specialty) July 08, 2007

Dentist (License #1915698 in IL)

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Initial NPI Registration & Enumeration November 15, 2006

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1508939018
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: November 15, 2006
Last Update: July 08, 2007
Deactivation Date: November 29, 2023

Mailing Address

1105 Carroll St., Po Box 860

Pawnee, IL 65558

Phone: 2176257953

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.