Provider Demographics
NPI:1124727185
Name:WATTS, VICKIE AMES (RDH)
Entity type:Individual
Prefix:MRS
First Name:VICKIE
Middle Name:AMES
Last Name:WATTS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1809 DEVONWOOD CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-6233
Mailing Address - Country:US
Mailing Address - Phone:850-291-2383
Mailing Address - Fax:
Practice Address - Street 1:1809 DEVONWOOD CT
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-6233
Practice Address - Country:US
Practice Address - Phone:850-291-2383
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-28
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH12387124Q00000X
TN6859124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist