Modern Orthodontics PLLC

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

Legal business name

MODERN ORTHODONTICS PLLC

Practice address

1030 Laurence Ave
Ste 4
Jackson, MI 49202

Phone

(517) 888-7338

NPI assigned

Oct 18, 2019

Last updated

Oct 18, 2019By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Scott A. Watterson, DDSNPI 1285643841

Title

Owner/Member

Phone

(517) 206-1445

Specialties & licenses 1

Addresses

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Scott A Watterson, DDS

  • General Practice Dentistry
  • Jackson, MI
  • NPI 1285643841
  Authorized official Same address or phone

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

{
    "created_epoch": "1571356800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571356800000",
    "number": "1851934236",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1030 LAURENCE AVE",
            "address_2": "STE 4",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49202",
            "telephone_number": "517-888-7338"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 LAURENCE AVE",
            "address_2": "STE 4",
            "city": "JACKSON",
            "state": "MI",
            "postal_code": "49202",
            "telephone_number": "517-888-7338"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MODERN ORTHODONTICS PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-18",
        "last_updated": "2019-10-18",
        "status": "A",
        "authorized_official_last_name": "WATTERSON",
        "authorized_official_first_name": "SCOTT",
        "authorized_official_middle_name": "A.",
        "authorized_official_title_or_position": "OWNER/MEMBER",
        "authorized_official_telephone_number": "517-206-1445",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Orthodontics and Dentofacial Orthopedics Dentistry in Jackson, MI
• Providers in Jackson, MI by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 18, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.