Provider Demographics
NPI:1841291283
Name:WATT, PRISCILLA ANTONNIETTE (RDH)
Entity type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:ANTONNIETTE
Last Name:WATT
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 1:941 MINNEAPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-1504
Mailing Address - Country:US
Mailing Address - Phone:757-474-9288
Mailing Address - Fax:
Practice Address - Street 1:941 MINNEAPOLIS DR
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23453-1504
Practice Address - Country:US
Practice Address - Phone:757-474-9288
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11867124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist