Healthcare Provider Details

I. General information

NPI: 1447420120
Provider Name (Legal Business Name): GEORGE E WATTERS III DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 04/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1212 BUTLER AVE
NEW CASTLE PA
16101
US

IV. Provider business mailing address

1212 BUTLER AVE
NEW CASTLE PA
16101
US

V. Phone/Fax

Practice location:
  • Phone: 724-652-9843
  • Fax: 724-652-6577
Mailing address:
  • Phone: 724-652-9843
  • Fax: 724-652-6577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS018178L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberDS018178L
License Number StatePA

VIII. Authorized Official

Name: GEORGE E WATTERS III DMD
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 724-652-9843