Provider Demographics
NPI:1235175423
Name:WATTERS, GEORGE E (DMD)
Entity Type:Individual
Prefix:
First Name:GEORGE
Middle Name:E
Last Name:WATTERS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1212 BUTLER AVE
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:PA
Mailing Address - Zip Code:16101
Mailing Address - Country:US
Mailing Address - Phone:724-652-9843
Mailing Address - Fax:724-652-6577
Practice Address - Street 1:1212 BUTLER AVE
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:PA
Practice Address - Zip Code:16101
Practice Address - Country:US
Practice Address - Phone:724-652-9843
Practice Address - Fax:724-652-6577
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS018178L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice