Jenna Kaye Waselues, D.D.S.

Primary specialty

DentistTaxonomy code 122300000X

License

4059 Issued in AR

Practice address

245 W Van Asche Dr
Fayetteville, AR 72703-4973

Phone

(479) 442-4051

Fax

(479) 442-5907

NPI assigned

Jun 29, 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 AR

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

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Samaritan House Community Center

  dba Samaritan Community Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Rogers, AR
  • NPI 1932953809
  Medicare reassignment NPD
• Lance Osborne DDS, PA

  • General Practice Dentistry
  • Fayetteville, AR
  • NPI 1609035534
  NPD (past)
• Samaritan House Community Center

  • General Practice Dentistry
  • Rogers, AR
  • NPI 1386370559
  NPD (past)

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

{
    "created_epoch": "1435536000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1435536000000",
    "number": "1982087722",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "245 W VAN ASCHE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034973",
            "telephone_number": "479-442-4051",
            "fax_number": "479-442-5907"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "245 W VAN ASCHE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727034973",
            "telephone_number": "479-442-4051",
            "fax_number": "479-442-5907"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WASELUES",
        "first_name": "JENNA",
        "middle_name": "KAYE",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-06-29",
        "last_updated": "2015-06-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "AR",
            "license": "4059",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Warren C. Massey, DDS, Ms. PA
• Amanda Nicole Warren, D.C.
• Andrea Warren
• Andrew Joseph Warren
• Dennis Joe Warren, D.C.
• Laura E Washburn
• Washington County Home Health Care Inc. (Alliance Home Health)
• Washington County Regional Ambulance Authority (Central EMS)
• Washington Regional Medical Center
• Washington Regional Medical Center

• Dentist in Fayetteville, AR
• Providers in Fayetteville, AR by specialty
• Dentist in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 29, 2015; 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.