Healthcare Provider Details

I. General information

NPI: 1164041588
Provider Name (Legal Business Name): KRISTEN WATTS DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2020
Last Update Date: 07/03/2024
Certification Date: 07/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2958 DOUGHERTY FERRY RD
SAINT LOUIS MO
63122-3366
US

IV. Provider business mailing address

1238 ARCH TER
SAINT LOUIS MO
63117-1402
US

V. Phone/Fax

Practice location:
  • Phone: 636-394-4275
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number2020038493
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: