Provider Demographics
NPI:1639161094
Name:WATT, CAROL WALKER (DDS)
Entity Type:Individual
Prefix:DR
First Name:CAROL
Middle Name:WALKER
Last Name:WATT
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 1:2797 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:INGLESIDE
Mailing Address - State:TX
Mailing Address - Zip Code:78362-5901
Mailing Address - Country:US
Mailing Address - Phone:361-776-5166
Mailing Address - Fax:361-776-2521
Practice Address - Street 1:2797 MAIN ST
Practice Address - Street 2:
Practice Address - City:INGLESIDE
Practice Address - State:TX
Practice Address - Zip Code:78362-5901
Practice Address - Country:US
Practice Address - Phone:361-776-5166
Practice Address - Fax:361-776-2521
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX194931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice