Provider Demographics
NPI:1508224098
Name:WATTS, VANESSA (DMD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 WALNUT ST NE
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33704-2350
Mailing Address - Country:US
Mailing Address - Phone:561-703-3438
Mailing Address - Fax:
Practice Address - Street 1:16305 FISHHAWK BLVD
Practice Address - Street 2:
Practice Address - City:LITHIA
Practice Address - State:FL
Practice Address - Zip Code:33547-3932
Practice Address - Country:US
Practice Address - Phone:813-642-6611
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 207721223S0112X
FLDN207721223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery