Active NPI
Jessica Wertz, DDS
- Dentist
- Watertown, WI
National Provider Identifier
1104568575
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6001162-15
- Practice address
- 123 Hospital Dr Ste 201
Watertown, WI 53098-3320 - Phone
- (920) 261-0588
- NPI assigned
- Apr 7, 2022
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6001162-15 | WI | Primary |
Addresses
Primary practice location
123 Hospital Dr Ste 201
Watertown, WI 53098-3320
Mailing address
14235 Sunrise Ave
Brookfield, WI 53005-1122
Phone (262) 408-0874
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001162-15 | WI | MD | Dentist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Family Dentistry, S.C. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- General Practice Dentistry
- Watertown, WI
- NPI 1861628133
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1649289600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1687392000000",
"number": "1104568575",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "14235 SUNRISE AVE",
"city": "BROOKFIELD",
"state": "WI",
"postal_code": "530051122",
"telephone_number": "262-408-0874"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "123 HOSPITAL DR STE 201",
"city": "WATERTOWN",
"state": "WI",
"postal_code": "530983320",
"telephone_number": "920-261-0588"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERTZ",
"first_name": "JESSICA",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-04-07",
"last_updated": "2023-06-22",
"certification_date": "2023-06-22",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6001162-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Watertown, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 22, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.