NPIMap

Organization Active NPI

Derek G. Watts, D.M.D.,M.S.,P.S.C.

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Hazard, KY
National Provider Identifier
1104832757
Registry record updated Feb 25, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X
License
7013 Issued in KY
Legal business name
DEREK G. WATTS, D.M.D.,M.S.,P.S.C.
Practice address
285 Black Gold Blvd
Hazard, KY 41701-2604
Phone
(606) 439-0881
Fax
(606) 439-1182
NPI assigned
Aug 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Feb 25, 2008

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

Authorized official

Name
Dr. Derek Gene Watts, D.M.D.,M.S.NPI 1578570784
Title
President
Phone
(606) 439-0881

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223X0400X 7013 KY Primary

Addresses

Primary practice location

285 Black Gold Blvd
Hazard, KY 41701-2604

Mailing address

285 Black Gold Blvd
Hazard, KY 41701-2604
Phone (606) 439-0881

Other identifiers 1

IdentifierTypeStateIssuer
60070133MedicaidKY

Other names 1

  • Hazard Orthodontic Clinic Doing business as

National Provider Directory

National Provider Directory

Locations

285 Black Gold Blvd
Hazard, KY 41701
Phone (606) 439-0881

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1203897600000",
    "number": "1104832757",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 BLACK GOLD BLVD",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417012604",
            "telephone_number": "606-439-0881",
            "fax_number": "606-439-1182"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "285 BLACK GOLD BLVD",
            "city": "HAZARD",
            "state": "KY",
            "postal_code": "417012604",
            "telephone_number": "606-439-0881",
            "fax_number": "606-439-1182"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DEREK G. WATTS, D.M.D.,M.S.,P.S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2008-02-25",
        "status": "A",
        "authorized_official_last_name": "WATTS",
        "authorized_official_first_name": "DEREK",
        "authorized_official_middle_name": "GENE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "606-439-0881",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D.,M.S."
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "KY",
            "license": "7013",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "60070133",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Hazard Orthodontic Clinic",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Hazard, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.