Healthcare Provider Details

I. General information

NPI: 1073648754
Provider Name (Legal Business Name): ROBERT K WATTS DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2007
Last Update Date: 04/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18283 N 93RD ST
SCOTTSDALE AZ
85255-6216
US

IV. Provider business mailing address

18283 N 93RD ST
SCOTTSDALE AZ
85255-6216
US

V. Phone/Fax

Practice location:
  • Phone: 480-375-1014
  • Fax:
Mailing address:
  • Phone: 480-375-1014
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number21734
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number7512
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: