Jessica L Woller, DMD, MSD, CO

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

162 Issued in AK

Practice address

1919 Lathrop St
Suite 102
Fairbanks, AK 99701-5937

Phone

(907) 452-2939

Fax

(907) 451-7330

NPI assigned

Aug 4, 2009

Last updated

Oct 29, 2009By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: jwoller@direct-searhc.org

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.

• Fairbanks Orthodontic Group, a Professional Corporation

  • Dental Clinic/Center
  • Fairbanks, AK
  • NPI 1376982918
  NPD (past) Authorized official
• Southeast Alaska Regional Health Consortium

  dba SEARHC Mt. Edgecumbe Medical Center

  • Critical Access Hospital
  • Sitka, AK
  • NPI 1720062524
  NPD
• Fairbanks Orthodontic Group a Prof Corp

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Fairbanks, AK
  • NPI 1013084680
  NPD (past)

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

{
    "created_epoch": "1249344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1256774400000",
    "number": "1164653473",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "SUITE 102",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015937",
            "telephone_number": "907-452-2939",
            "fax_number": "907-451-7330"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1919 LATHROP ST",
            "address_2": "SUITE 102",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997015937",
            "telephone_number": "907-452-2939",
            "fax_number": "907-451-7330"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOLLER",
        "first_name": "JESSICA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "DMD, MSD, CO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-08-04",
        "last_updated": "2009-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AK",
            "license": "1249",
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "AK",
            "license": "162",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shannon Winterton
• Lauren Wise
• David Witham, M.D.
• Sarah Louise Witt, MS. ED.
• Sherry Lynne Wolf, RN,MSN,ANP
• Jonathan P Woller, D.M.D.
• Timothy John Woller, D.D.S.
• Brenda Renee Wolverton, P.T.
• Stephanie H Won, RN
• Kimberly Janne Wonderlich, M.D.

• Orthodontics and Dentofacial Orthopedics Dentistry in Fairbanks, AK
• Providers in Fairbanks, AK by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2009; 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.