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General NPI Number Information
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NPI Number | 1598850448
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Entity Type | Organization
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Legal Business Name | TERRELL A WATERS DDS PC
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4300 WHEELER ROAD SE
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City | WASHINGTON
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State | DC
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Zip | 20032-6036
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Country | US
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Telephone | 202-562-8827
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Fax | 202-563-4160
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Provider Business Mailing Address
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Address Line | 4300 WHEELER ROAD SE
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City | WASHINGTON
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State | DC
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Zip | 20032-6036
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Country | US
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Telephone | 202-562-8827
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Fax | 202-563-4160
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TERRELL ANTHONY WATERS
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Credential | DDS
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Telephone | 202-562-8827
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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 | 3829
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN10233
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DEN2248
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License Number State | DC
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