Healthcare Provider Details

I. General information

NPI: 1568423481
Provider Name (Legal Business Name): AARON WATMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 ARCAND DR
LOWELL MA
01852-1026
US

IV. Provider business mailing address

25 BLACK HORSE DR
ACTON MA
01720-2046
US

V. Phone/Fax

Practice location:
  • Phone: 978-323-4399
  • Fax: 978-459-6665
Mailing address:
  • Phone: 978-263-0045
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number17094
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number3217
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: