Provider Demographics
NPI:1407300635
Name:WATTS & PLA DMD MSD PLLC
Entity Type:Organization
Organization Name:WATTS & PLA DMD MSD PLLC
Other - Org Name:PLA & WATTS ENDODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KRISTOPHER
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-623-7266
Mailing Address - Street 1:2302 S. UNION AVE A-1
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-212-1752
Mailing Address - Fax:253-267-5196
Practice Address - Street 1:2302 S. UNION AVE A-1
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-212-1752
Practice Address - Fax:253-267-5196
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2019-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty