MEDICARE: DR. JOHN H WATTS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	308199	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245285592
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN H WATTS DDS

Provider Business Mailing Address
First Line	:	66 BAYOU CIR
Second Line	:
City	:	GULFPORT
State	:	MS
Zip	:	39507-4618
Country	:	US
Telephone Number	:	228-388-5925
Fax Number	:	228-388-8153

Provider Business Practice Location Address
First Line	:	1760 MEDICAL PARK DR
Second Line	:	SUTIE A
City	:	BILOXI
State	:	MS
Zip	:	39532-2131
Country	:	US
Telephone Number	:	228-388-5925
Fax Number	:	228-388-8153

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/24/2006
Last Update Date	:	07/08/2007

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