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General NPI Number Information
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NPI Number | 1487636122
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Entity Type | Individual
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Provider Name | PHILLIP E. WATT DDS
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Gender | Male
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Dates
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Enumeration Date | 11/17/2005
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Last Update Date | 02/05/2016
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Provider Practice Location Address
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Address Line | 2056 S SHERIDAN AVE
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City | SHERIDAN
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State | WY
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Zip | 82801-6105
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Country | US
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Telephone | 307-672-2421
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Fax |
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Provider Business Mailing Address
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Address Line | 2056 S SHERIDAN AVE
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City | SHERIDAN
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State | WY
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Zip | 82801-6105
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Country | US
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Telephone | 307-672-2421
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 814
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License Number State | WY
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