Tetsuji Zenas Watari, DDS

Primary specialty

PeriodonticsTaxonomy code 1223P0300X

License

D9047 Issued in OR

Practice address

2930 E Barnett Rd
Medford, OR 97504

Phone

(541) 779-5401

Fax

(541) 779-8674

NPI assigned

Feb 20, 2008

Last updated

Feb 20, 2008By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1203465600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1203465600000",
    "number": "1639347958",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2930 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-779-5401",
            "fax_number": "541-779-8674"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2930 E BARNETT RD",
            "city": "MEDFORD",
            "state": "OR",
            "postal_code": "97504",
            "telephone_number": "541-779-5401",
            "fax_number": "541-779-8674"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATARI",
        "first_name": "TETSUJI",
        "middle_name": "ZENAS",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-02-20",
        "last_updated": "2008-02-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0300X",
            "taxonomy_group": "",
            "desc": "Dentist, Periodontics",
            "state": "OR",
            "license": "D9047",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jonathan Jay Warrick
• Warriors Journey Forward
• Holly May Wasche, RN
• Mary Lynn Wasmund
• Kaitlyn Elizabeth Waszak
• Vanessa J Waterbury
• Waterford Operations, LLC (Avamere at Three Fountains)
• Susan Ann Waterman, LCSW
• Erin M Watkins, LICENSED DENTURIST
• Jennifer Watkins, BA, MA, PSY.D., QMHP

• Periodontics in Medford, OR
• Providers in Medford, OR by specialty
• Periodontics in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2008; 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.