Provider Demographics
NPI:1831612043
Name:WATTS FAMILY DENTISTRY
Entity type:Organization
Organization Name:WATTS FAMILY DENTISTRY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:H.
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:812-379-9792
Mailing Address - Street 1:3146 N NATIONAL RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-3169
Mailing Address - Country:US
Mailing Address - Phone:812-379-9792
Mailing Address - Fax:812-375-1395
Practice Address - Street 1:3146 N NATIONAL RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-3169
Practice Address - Country:US
Practice Address - Phone:812-379-9792
Practice Address - Fax:812-375-1395
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WATTS FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-19
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100052860AMedicaid