Active NPI
Joseph Jack Widdison, DMD
- Dentist
- Windsor, CO
National Provider Identifier
1184839623
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 9379
- Practice address
- 1555 Main St
Suite a-2
Windsor, CO 80550-5998 - Phone
- (970) 690-9823
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 26396 | TX | |
| Dentist | 122300000X | 9379 | CO | Primary |
Addresses
Primary practice location
1555 Main St
Suite a-2
Windsor, CO 80550-5998
Mailing address
1555 Main St
Suite a-2
Windsor, CO 80550-5998
Phone (970) 690-9823
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 |
|---|---|---|---|
| 9379 | CO | MD | Dentist |
| 26396 | TX | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1178755200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1428278400000",
"number": "1184839623",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1555 MAIN ST",
"address_2": "SUITE A-2",
"city": "WINDSOR",
"state": "CO",
"postal_code": "805505998",
"telephone_number": "970-690-9823"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1555 MAIN ST",
"address_2": "SUITE A-2",
"city": "WINDSOR",
"state": "CO",
"postal_code": "805505998",
"telephone_number": "970-690-9823"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WIDDISON",
"first_name": "JOSEPH",
"middle_name": "JACK",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-05-10",
"last_updated": "2015-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "26396",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "CO",
"license": "9379",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Windsor, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.