Jill Watson, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

0401414943 Issued in VA

Practice address

4881 Sugar Maple Dr
Wpafb, OH 45433-5529

Phone

(372) 579-8761

NPI assigned

Feb 11, 2015

Sex

Female

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 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

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1423612800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690502400000",
    "number": "1669863734",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "372-579-8761"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4881 SUGAR MAPLE DR",
            "city": "WPAFB",
            "state": "OH",
            "postal_code": "454335529",
            "telephone_number": "372-579-8761"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1615 Truemper St Bldg 6418",
            "address_purpose": "LOCATION",
            "city": "Lackland AFB",
            "state": "TX",
            "postal_code": "78236",
            "country_code": "US",
            "telephone_number": "303-929-4881",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "76 Nealy Blvd",
            "address_purpose": "LOCATION",
            "city": "Hampton",
            "state": "VA",
            "postal_code": "236652022",
            "country_code": "US",
            "telephone_number": "757-225-1523",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATSON",
        "first_name": "JILL",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-02-11",
        "last_updated": "2023-07-28",
        "certification_date": "2023-07-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "VA",
            "license": "0401414943",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Martin Inocentes Vicente
• Kristin Vogt, MD
• Lynda K Vu, M.D.
• Richard Adam Waggoner, PHYSICIAN ASSISTANT
• James Allen Wainright
• Sarah Marie Wesely, DO
• Drew Eric Widing, PT
• Ra'Mone Williams, AU.D.
• Tory W Woodard, MD
• Stephen R Yerian, PSY D

• General Practice Dentistry in Wpafb, OH
• Providers in Wpafb, OH by specialty
• General Practice Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 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.