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General NPI Number Information
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NPI Number | 1275156499
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Entity Type | Individual
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Provider Name | LAURA ELIZABETH WATTERSON DMD
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Gender | Female
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Dates
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Enumeration Date | 05/21/2020
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Last Update Date | 04/12/2022
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Provider Practice Location Address
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Address Line | 1175 MAIN ST
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City | RAMONA
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State | CA
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Zip | 92065-2122
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Country | US
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Telephone | 760-789-2882
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Fax |
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Provider Business Mailing Address
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Address Line | 253 EBONY AVE
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City | IMPERIAL BEACH
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State | CA
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Zip | 91932-2513
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Country | US
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Telephone | 307-286-8864
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | .00000005
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 106041
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License Number State | CA
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