Roger Carl Worthington, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

5515 Issued in KY

Practice address

1484 Lakeside Drive
Dental Suite
Jackson, KY 41339

Phone

(606) 666-9950

Fax

(606) 666-9136

NPI assigned

Sep 12, 2005

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 identifiers 2

Medicare fee-for-service enrollment

Enrolled in AL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

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.

• Daleville Dental II, LLC

  • General Practice Dentistry
  • Daleville, AL
  • NPI 1396471843
  NPD (past)
• Daleville Dental, LLC

  • General Practice Dentistry
  • Daleville, AL
  • NPI 1760477251
  NPD (past)

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

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1417942913",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 690",
            "city": "BEATTYVILLE",
            "state": "KY",
            "postal_code": "413110690",
            "telephone_number": "066-464-0151",
            "fax_number": "606-464-0152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1484 LAKESIDE DRIVE",
            "address_2": "DENTAL SUITE",
            "city": "JACKSON",
            "state": "KY",
            "postal_code": "41339",
            "telephone_number": "606-666-9950",
            "fax_number": "606-666-9136"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "308 N KY 7",
            "address_2": "Dental Suite",
            "address_purpose": "LOCATION",
            "city": "Sandy Hook",
            "state": "KY",
            "postal_code": "41711",
            "country_code": "US",
            "telephone_number": "606-738-9785",
            "fax_number": "859-317-2148",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "672 Main St",
            "address_purpose": "LOCATION",
            "city": "West Liberty",
            "state": "KY",
            "postal_code": "414721018",
            "country_code": "US",
            "telephone_number": "606-743-3030",
            "fax_number": "606-743-7480",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "60 Center St",
            "address_purpose": "LOCATION",
            "city": "Beattyville",
            "state": "KY",
            "postal_code": "413119085",
            "country_code": "US",
            "telephone_number": "606-464-9262",
            "fax_number": "606-208-8122",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WORTHINGTON",
        "first_name": "ROGER",
        "middle_name": "CARL",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2023-05-02",
        "certification_date": "2023-05-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5515",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "UCCI",
            "identifier": "1669988",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100437870",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tiffany Ann White, FNP-BC
• Edna Elizabeth Williams, APRN
• Jessica Williams
• Wolfe County Clinics
• Dreama Wooton, CDDC,LPCC
• Daniel Brent Yarbrough
• Clemente V. Zulueta Jr., MD

• General Practice Dentistry in Jackson, KY
• Providers in Jackson, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 2, 2023; 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.

Verify at the official NPI Registry.