Healthcare Provider Details

I. General information

NPI: 1790679157
Provider Name (Legal Business Name): JACOB WATTS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2025
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3476 SHERIDAN DR
AMHERST NY
14226-1545
US

IV. Provider business mailing address

3476 SHERIDAN DR
AMHERST NY
14226-1545
US

V. Phone/Fax

Practice location:
  • Phone: 716-332-2444
  • Fax:
Mailing address:
  • Phone: 716-332-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number065381
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDS045002
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: