Provider Demographics
NPI:1326140922
Name:MCWATTERS, TERRY LEE (DDS)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:LEE
Last Name:MCWATTERS
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 1:2201 22ND STREET
Mailing Address - Street 2:
Mailing Address - City:NITRO
Mailing Address - State:WV
Mailing Address - Zip Code:25143
Mailing Address - Country:US
Mailing Address - Phone:304-755-2161
Mailing Address - Fax:304-755-7140
Practice Address - Street 1:2201 22ND STREET
Practice Address - Street 2:
Practice Address - City:NITRO
Practice Address - State:WV
Practice Address - Zip Code:25143
Practice Address - Country:US
Practice Address - Phone:304-755-2161
Practice Address - Fax:304-755-7140
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV2893122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV00608566OtherOSCAR
WV0132649000Medicaid