Michael Robert Wattles, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

3697 Issued in AR

Practice address

1115 Morgan St
Carlinville, IL 62626-1438

Phone

(217) 854-3223

NPI assigned

Mar 12, 2009

Last updated

Mar 2, 2026By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in IL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: michael.wattles.p30@direct.fhn-fqhc.nextgenshare.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Gillespie, IL
  • NPI 1538444906
  Medicare reassignment NPD
• Macoupin County Public Health Department

  • Federally Qualified Health Center (FQHC)
  • Carlinville, IL
  • NPI 1184351173
  NPD
• Macoupin County Public Health Department

  dba St Francis Way Clinic

  • Federally Qualified Health Center (FQHC)
  • Litchfield, IL
  • NPI 1720687841
  NPD
• Macoupin County Public Health Department

  • Public Health or Welfare Agency
  • Gillespie, IL
  • NPI 1447388392
  NPD (past)
• Modern Dental Professionals-Smith PA

  dba Monarch Dental

  • General Practice Dentistry
  • Pine Bluff, AR
  • NPI 1538232566
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1236816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1772409600000",
    "number": "1093956534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "205 OAKLAND AVE",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261921",
            "telephone_number": "217-854-3223"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1115 MORGAN ST",
            "city": "CARLINVILLE",
            "state": "IL",
            "postal_code": "626261438",
            "telephone_number": "217-854-3223"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "8700 S 36th Ter",
            "address_purpose": "LOCATION",
            "city": "Fort Smith",
            "state": "AR",
            "postal_code": "729088797",
            "country_code": "US",
            "telephone_number": "479-646-1979",
            "fax_number": "479-646-1223",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATTLES",
        "first_name": "MICHAEL",
        "middle_name": "ROBERT",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-12",
        "last_updated": "2026-03-02",
        "certification_date": "2026-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "3697",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Carlinville, IL
• Providers in Carlinville, IL by specialty
• Dentist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.