Provider Demographics
NPI:1760507255
Name:GARY L. WATTS DMD PC
Entity Type:Organization
Organization Name:GARY L. WATTS DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GARY
Authorized Official - Middle Name:L
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:770-463-4541
Mailing Address - Street 1:501 PARK ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO
Mailing Address - State:GA
Mailing Address - Zip Code:30268-1007
Mailing Address - Country:US
Mailing Address - Phone:770-463-4541
Mailing Address - Fax:770-463-9184
Practice Address - Street 1:501 PARK ST
Practice Address - Street 2:
Practice Address - City:PALMETTO
Practice Address - State:GA
Practice Address - Zip Code:30268-1007
Practice Address - Country:US
Practice Address - Phone:770-463-4541
Practice Address - Fax:770-463-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0086271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty