Provider Demographics
NPI:1629143094
Name:WATTS, CHARLES ARTHUR (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:ARTHUR
Last Name:WATTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 E PURISIMA
Mailing Address - Street 2:PO BOX 100
Mailing Address - City:REFUGIO
Mailing Address - State:TX
Mailing Address - Zip Code:78377-0100
Mailing Address - Country:US
Mailing Address - Phone:361-526-2911
Mailing Address - Fax:361-526-4166
Practice Address - Street 1:203 E PURISIMA
Practice Address - Street 2:
Practice Address - City:REFUGIO
Practice Address - State:TX
Practice Address - Zip Code:78377-0100
Practice Address - Country:US
Practice Address - Phone:361-526-2911
Practice Address - Fax:361-526-4166
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX137031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice