Glenn Stewart Waters, D.D.S.,M.D.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

30022099 Issued in OH

Practice address

10506 Montgomery Rd
Suite 203
Cincinnati, OH 45242-4487

Phone

(513) 791-0550

Fax

(513) 791-1517

NPI assigned

Apr 7, 2006

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

Other names 1

• Dr. Glenn Stewart Waters Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Jul 1, 2013 through Jul 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1144368000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1245293604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10506 MONTGOMERY RD",
            "address_2": "SUITE 203",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452424487",
            "telephone_number": "513-791-0550",
            "fax_number": "513-791-1517"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10506 MONTGOMERY RD",
            "address_2": "SUITE 203",
            "city": "CINCINNATI",
            "state": "OH",
            "postal_code": "452424487",
            "telephone_number": "513-791-0550",
            "fax_number": "513-791-1517"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "GLENN",
        "middle_name": "STEWART",
        "name_prefix": "Dr.",
        "credential": "D.D.S.,M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "OH",
            "license": "30022099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "GLENN",
            "last_name": "WATERS",
            "middle_name": "STEWART",
            "prefix": "DR.",
            "credential": "D.D.S.,M.D.",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Luis Carlos Watanabe Tejada, M.D.
• Miho Watanabe
• Toshiyuki Watanabe, DPT
• David M Waterhouse, MD
• Cindy Jo Waters
• Keisha Renee Waters, LCDCIII
• Margo Waters, MD
• Megan Suzanne Waters, PA-C
• Ryan Joseph Waters, CRNA
• Suzanne Carol Waters

• Oral and Maxillofacial Surgery (Dentist) in Cincinnati, OH
• Providers in Cincinnati, OH by specialty
• Oral and Maxillofacial Surgery (Dentist) in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.