Jessica Jill Waterbury, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

D13437 Issued in MN

Practice address

1926 Collegeview Rd E
HC 116
Rochester, MN 55904-8201

Phone

(507) 258-4046

NPI assigned

Jul 14, 2014

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 9, 2021 through Nov 9, 2027

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Dental Care

  • General Practice Dentistry
  • Rochester, MN
  • NPI 1548709330
  NPD (past)
• Community Dental Care

  • General Practice Dentistry
  • Rochester, MN
  • NPI 1891100772
  NPD (past)

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

{
    "created_epoch": "1405296000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1425254400000",
    "number": "1407263247",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1926 COLLEGEVIEW RD E",
            "address_2": "HC 116",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559048201",
            "telephone_number": "507-258-4046"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1926 COLLEGEVIEW RD E",
            "address_2": "HC 116",
            "city": "ROCHESTER",
            "state": "MN",
            "postal_code": "559048201",
            "telephone_number": "507-258-4046"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERBURY",
        "first_name": "JESSICA",
        "middle_name": "JILL",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2014-07-14",
        "last_updated": "2015-03-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MN",
            "license": "D13437",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kenneth J Warrington, MD
• Fadumo Mowleed Warsame, MD
• Rahma M Warsame, MD
• Leslie Anne Washburn, PA-C
• Charles T Wass, M.D.
• Conor Waters
• Amirah Tajah Watkins
• Ryan Davis Watkins, MD
• Emily Watrud
• Annaliese Noelle Watson, LPC

• Dentist in Rochester, MN
• Providers in Rochester, MN by specialty
• Dentist in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 2, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.