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General NPI Number Information
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NPI Number | 1598945511
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Entity Type | Organization
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Legal Business Name | CHRISTOPHER R WATERS DDS PC
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Dates
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Enumeration Date | 11/07/2007
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Last Update Date | 07/14/2008
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Provider Practice Location Address
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Address Line | 2916 W STOLLEY PARK RD
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City | GRAND ISLAND
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State | NE
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Zip | 68801
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Country | US
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Telephone | 308-382-1734
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Fax | 308-382-1784
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Provider Business Mailing Address
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Address Line | 2916 W STOLLEY PARK RD
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City | GRAND ISLAND
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State | NE
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Zip | 68801
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Country | US
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Telephone | 308-382-1734
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Fax | 308-382-1784
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Authorized Official
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Title or Position | OWNER DENTIST
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Name | DR. CHRISTOPHER R WATERS
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Credential | DDS
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Telephone | 308-382-1734
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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 | 5631
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License Number State | NE
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