Healthcare Provider Details

I. General information

NPI: 1104759042
Provider Name (Legal Business Name): RONAN PATRICK WATERSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2300 MAIN ST
PARSONS KS
67357-2724
US

IV. Provider business mailing address

2300 MAIN ST
PARSONS KS
67357-2724
US

V. Phone/Fax

Practice location:
  • Phone: 620-421-4940
  • Fax: 620-421-4941
Mailing address:
  • Phone: 620-421-4940
  • Fax: 620-421-4941

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number62363
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: