Provider Demographics
NPI:1134614613
Name:WATTERS, MARIN ILENE PARSONS (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIN
Middle Name:ILENE PARSONS
Last Name:WATTERS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:MARIN
Other - Middle Name:ILENE
Other - Last Name:PARSONS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:4706 XERXES AVE N
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55430-3732
Mailing Address - Country:US
Mailing Address - Phone:651-398-7931
Mailing Address - Fax:
Practice Address - Street 1:7501 GOLDEN VALLEY RD
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4584
Practice Address - Country:US
Practice Address - Phone:763-544-2213
Practice Address - Fax:763-541-1758
Is Sole Proprietor?:No
Enumeration Date:2018-06-26
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND14073122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist