Provider Demographics
NPI:1053448761
Name:WATERS, PAUL (DDS)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1855 PIEDMONT RD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-4271
Mailing Address - Country:US
Mailing Address - Phone:770-565-0132
Mailing Address - Fax:
Practice Address - Street 1:1855 PIEDMONT RD
Practice Address - Street 2:STE. 102
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30066-4271
Practice Address - Country:US
Practice Address - Phone:770-565-0132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA99861223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice