Active NPI
Scott A Watterson, DDS
- General Practice Dentistry
- Jackson, MI
National Provider Identifier
1285643841
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 2901017509
- Practice address
- 1030 Laurence Ave
Ste 4
Jackson, MI 49202 - Phone
- (517) 782-1467
- Fax
- (517) 782-3659
- NPI assigned
- Aug 5, 2006
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 2901017509 | MI | Primary |
Addresses
Primary practice location
1030 Laurence Ave
Ste 4
Jackson, MI 49202
Mailing address
1030 Laurence Ave
Ste 4
Jackson, MI 49202
Phone (517) 782-1467
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in MI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160411001263 | MI | Order and Referring Only - Oral Surgery | 2062710924 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154736000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1568160000000",
"number": "1285643841",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1030 LAURENCE AVE",
"address_2": "STE 4",
"city": "JACKSON",
"state": "MI",
"postal_code": "49202",
"telephone_number": "517-782-1467",
"fax_number": "517-782-3659"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1030 LAURENCE AVE",
"address_2": "STE 4",
"city": "JACKSON",
"state": "MI",
"postal_code": "49202",
"telephone_number": "517-782-1467",
"fax_number": "517-782-3659"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WATTERSON",
"first_name": "SCOTT",
"middle_name": "A",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-08-05",
"last_updated": "2019-09-11",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "MI",
"license": "2901017509",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jackson, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2019; 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.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.