Individual provider Active NPI

Renee E Watts, DDS

  • General Practice Dentistry
  • Springfield, OR
National Provider Identifier
1568469393
Registry record updated Feb 20, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
D7573 Issued in OR
Practice address
1040 Gateway Loop Ste B
Springfield, OR 97477-1196
Phone
(541) 465-9821
Fax
(541) 988-1825
NPI assigned
Jul 7, 2005
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Feb 20, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X D7573 OR Primary

Addresses

Primary practice location

1040 Gateway Loop Ste B
Springfield, OR 97477-1196

Mailing address

498 Harlow Rd
Suite 1
Springfield, OR 97477-1336
Phone (541) 465-9821

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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

Enrollment IDStateProvider typePAC IDDetails
I20150729007495 OR Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 2163605965

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D7573ORMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Renee E Watts DDS PC CurrentSince Mar 21, 2011 Accepting new patients

Locations

498 Harlow Rd
Ste 1
Springfield, OR 97477
Phone (541) 465-9821

1040 Gateway Loop
Ste B
Springfield, OR 97477
Phone (541) 465-9821

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1120694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550620800000",
    "number": "1568469393",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "498 HARLOW RD",
            "address_2": "SUITE 1",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771336",
            "telephone_number": "541-465-9821",
            "fax_number": "541-988-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1040 GATEWAY LOOP STE B",
            "city": "SPRINGFIELD",
            "state": "OR",
            "postal_code": "974771196",
            "telephone_number": "541-465-9821",
            "fax_number": "541-988-1825"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATTS",
        "first_name": "RENEE",
        "middle_name": "E",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2005-07-07",
        "last_updated": "2019-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D7573",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Springfield, OR

Sources for this page

Verify at the official NPI Registry.