Provider Demographics
NPI:1629230750
Name:WATT DENTAL CLINIC, P.C.
Entity Type:Organization
Organization Name:WATT DENTAL CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:307-672-2421
Mailing Address - Street 1:2056 S SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-6105
Mailing Address - Country:US
Mailing Address - Phone:307-672-2421
Mailing Address - Fax:307-674-4285
Practice Address - Street 1:2056 S SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-6105
Practice Address - Country:US
Practice Address - Phone:307-672-2421
Practice Address - Fax:307-674-4285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY10971223G0001X
WY8141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty