Individual provider Active NPI

William Emerick Waters, D.D.S.

  • General Practice Dentistry
  • Cleveland, OH
National Provider Identifier
1609193846
Registry record updated Apr 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
18064 Issued in OH
Practice address
3865 Rocky River Dr.
#7
Cleveland, OH 44111
Phone
(216) 941-4900
Fax
(216) 941-1419
NPI assigned
Apr 28, 2010
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 28, 2010

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 18064 OH Primary

Addresses

Primary practice location

3865 Rocky River Dr.
#7
Cleveland, OH 44111

Mailing address

3865 Rocky River Dr.
#7
Cleveland, OH 44111
Phone (216) 941-4900

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OH
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
I20150604001898 OH Order and Referring Only - DentistPractitioner - Dentist 4880915651

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
18064OHMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
Riveredge Dentistry Inc Past Accepting new patients

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": "1272412800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1272412800000",
    "number": "1609193846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3865 ROCKY RIVER DR.",
            "address_2": "#7",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44111",
            "telephone_number": "216-941-4900",
            "fax_number": "216-941-1419"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3865 ROCKY RIVER DR.",
            "address_2": "#7",
            "city": "CLEVELAND",
            "state": "OH",
            "postal_code": "44111",
            "telephone_number": "216-941-4900",
            "fax_number": "216-941-1419"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERS",
        "first_name": "WILLIAM",
        "middle_name": "EMERICK",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2010-04-28",
        "last_updated": "2010-04-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OH",
            "license": "18064",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Cleveland, OH

Sources for this page

Verify at the official NPI Registry.