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General NPI Number Information
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NPI Number | 1164507513
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Entity Type | Organization
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Legal Business Name | WATTERWORTH ORTHODONTICS, PA
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Dates
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Enumeration Date | 10/26/2006
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Last Update Date | 08/31/2010
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Provider Practice Location Address
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Address Line | 230 LAFAYETTE RD BLDG. D.
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City | PORTSMOUTH
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State | NH
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Zip | 03801-5465
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Country | US
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Telephone | 603-431-7616
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Fax |
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Provider Business Mailing Address
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Address Line | 230 LAFAYETTE RD BLDG. D.
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City | PORTSMOUTH
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State | NH
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Zip | 03801-5465
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRAD WATTERWORTH
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Credential |
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Telephone | 603-431-7616
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number |
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License Number State |
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