Provider Demographics
NPI:1598850448
Name:TERRELL A WATERS DDS PC
Entity Type:Organization
Organization Name:TERRELL A WATERS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TERRELL
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:202-562-8827
Mailing Address - Street 1:4300 WHEELER ROAD SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-6036
Mailing Address - Country:US
Mailing Address - Phone:202-562-8827
Mailing Address - Fax:202-563-4160
Practice Address - Street 1:4300 WHEELER ROAD SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-6036
Practice Address - Country:US
Practice Address - Phone:202-562-8827
Practice Address - Fax:202-563-4160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN22481223G0001X
MD38291223G0001X
FLDN102331223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
104664OtherDORAL