Healthcare Provider Details

I. General information

NPI: 1689257834
Provider Name (Legal Business Name): WATTS ORTHODONTICS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2021
Last Update Date: 05/04/2021
Certification Date: 05/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 RAMPART RANGE RD
WOODLAND PARK CO
80863-2428
US

IV. Provider business mailing address

7560 RANGEWOOD DR STE 200
COLORADO SPRINGS CO
80920-2100
US

V. Phone/Fax

Practice location:
  • Phone: 719-596-3113
  • Fax: 719-325-0244
Mailing address:
  • Phone: 719-623-5396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: CYNDIE LOU PLUID
Title or Position: OFFICE MANAGAGER
Credential:
Phone: 719-623-5396