Provider Demographics
NPI:1801933890
Name:WATTS DENTAL ASSOCIATES
Entity type:Organization
Organization Name:WATTS DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:301-780-7602
Mailing Address - Street 1:PO BOX 805
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20773-0805
Mailing Address - Country:US
Mailing Address - Phone:301-780-7602
Mailing Address - Fax:301-780-7606
Practice Address - Street 1:7611 S OSBORNE RD STE 102
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4238
Practice Address - Country:US
Practice Address - Phone:301-780-7602
Practice Address - Fax:301-780-7606
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2011-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty