Provider Demographics
NPI:1568469393
Name:WATTS, RENEE E (DDS)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:E
Last Name:WATTS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:498 HARLOW RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-1336
Mailing Address - Country:US
Mailing Address - Phone:541-465-9821
Mailing Address - Fax:541-988-1825
Practice Address - Street 1:1040 GATEWAY LOOP STE B
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-1196
Practice Address - Country:US
Practice Address - Phone:541-465-9821
Practice Address - Fax:541-988-1825
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2019-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD75731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice