Provider Demographics
NPI:1558445361
Name:MAUTERER, CAROLYN WATT (DDS)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:WATT
Last Name:MAUTERER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:WATT
Other - Last Name:SEABURY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2800 E. 136TH AVE
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80241
Mailing Address - Country:US
Mailing Address - Phone:720-872-2892
Mailing Address - Fax:720-872-2894
Practice Address - Street 1:2800 E 136TH AVE
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80241
Practice Address - Country:US
Practice Address - Phone:720-872-2892
Practice Address - Fax:720-872-2894
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO90031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice