Provider Demographics
NPI:1912351834
Name:WATERS, JERIN (RDH)
Entity Type:Individual
Prefix:
First Name:JERIN
Middle Name:
Last Name:WATERS
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:JERIN
Other - Middle Name:RACHEL
Other - Last Name:HAWTHORNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RDH
Mailing Address - Street 1:5780 N CAREFREE CIR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80917-2795
Mailing Address - Country:US
Mailing Address - Phone:702-373-7627
Mailing Address - Fax:
Practice Address - Street 1:5780 N CAREFREE CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-2795
Practice Address - Country:US
Practice Address - Phone:702-373-7627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-17
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906335124Q00000X
NV101363124Q00000X
NC7994124Q00000X
SC3683124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist