Healthcare Provider Details

I. General information

NPI: 1902028467
Provider Name (Legal Business Name): JAMES DUSTIN WATTS D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 08/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 E LAYFAIR DR SUITE 120
FLOWOOD MS
39232-7604
US

IV. Provider business mailing address

201 E LAYFAIR DR SUITE 120
FLOWOOD MS
39232-7604
US

V. Phone/Fax

Practice location:
  • Phone: 601-664-1855
  • Fax: 601-664-1856
Mailing address:
  • Phone: 601-664-1855
  • Fax: 601-664-1856

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number3143-00
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number0401411945
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: