Provider Demographics
NPI:1245404714
Name:WATERS, JEFFREY KENT (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:KENT
Last Name:WATERS
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2680 LAWRENCEVILLE HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:DECATUR
Mailing Address - State:GA
Mailing Address - Zip Code:30033-2500
Mailing Address - Country:US
Mailing Address - Phone:678-990-8034
Mailing Address - Fax:770-934-7176
Practice Address - Street 1:2680 LAWRENCEVILLE HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:DECATUR
Practice Address - State:GA
Practice Address - Zip Code:30033-2500
Practice Address - Country:US
Practice Address - Phone:678-990-8034
Practice Address - Fax:770-934-7176
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-16
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0131251223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics