Provider Demographics
NPI:1912919093
Name:WATTS, LARRY N (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:N
Last Name:WATTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:LAWERENCE
Other - Middle Name:N
Other - Last Name:WATTS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:13478 TIERRA OAKS DR
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-8011
Mailing Address - Country:US
Mailing Address - Phone:530-275-5567
Mailing Address - Fax:
Practice Address - Street 1:2315 BECHELLI LN
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0119
Practice Address - Country:US
Practice Address - Phone:530-223-0797
Practice Address - Fax:530-223-2403
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice