Provider Demographics
NPI:1578083671
Name:WATTS, KELLIE MCADAMS (DMD)
Entity Type:Individual
Prefix:DR
First Name:KELLIE
Middle Name:MCADAMS
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 1:772 LAKE HARBOUR DR STE 2
Mailing Address - Street 2:
Mailing Address - City:RIDGELAND
Mailing Address - State:MS
Mailing Address - Zip Code:39157-4365
Mailing Address - Country:US
Mailing Address - Phone:601-607-7876
Mailing Address - Fax:
Practice Address - Street 1:772 LAKE HARBOUR DR STE 2
Practice Address - Street 2:
Practice Address - City:RIDGELAND
Practice Address - State:MS
Practice Address - Zip Code:39157-4365
Practice Address - Country:US
Practice Address - Phone:601-607-7876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-21
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3936-171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice