Provider Demographics
NPI:1477759793
Name:JOHN S. WATERS D.D.S. P.C.
Entity Type:Organization
Organization Name:JOHN S. WATERS D.D.S. P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:STUART
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:815-786-2146
Mailing Address - Street 1:420 E CHURCH ST
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548-2206
Mailing Address - Country:US
Mailing Address - Phone:815-786-2146
Mailing Address - Fax:815-786-2147
Practice Address - Street 1:420 E CHURCH ST
Practice Address - Street 2:
Practice Address - City:SANDWICH
Practice Address - State:IL
Practice Address - Zip Code:60548-2206
Practice Address - Country:US
Practice Address - Phone:815-786-2146
Practice Address - Fax:815-786-2147
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty