Healthcare Provider Details

I. General information

NPI: 1659459725
Provider Name (Legal Business Name): ROBERT RAYMOND WATTS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1284 W GRAND RIVER RD
WILLIAMSTON MI
48895-9374
US

IV. Provider business mailing address

1284 W GRAND RIVER RD
WILLIAMSTON MI
48895-9374
US

V. Phone/Fax

Practice location:
  • Phone: 517-655-2993
  • Fax: 517-655-1380
Mailing address:
  • Phone: 517-655-2993
  • Fax: 517-655-1380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number14480
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: