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General NPI Number Information
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NPI Number | 1477759793
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Entity Type | Organization
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Legal Business Name | JOHN S. WATERS D.D.S. P.C.
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Dates
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Enumeration Date | 06/24/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 420 E CHURCH ST
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City | SANDWICH
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State | IL
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Zip | 60548-2206
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Country | US
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Telephone | 815-786-2146
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Fax | 815-786-2147
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Provider Business Mailing Address
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Address Line | 420 E CHURCH ST
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City | SANDWICH
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State | IL
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Zip | 60548-2206
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Country | US
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Telephone | 815-786-2146
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Fax | 815-786-2147
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JOHN STUART WATERS
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Credential | D.D.S.
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Telephone | 815-786-2146
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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 |
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License Number State | IL
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