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General NPI Number Information
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NPI Number | 1659252104
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Entity Type | Organization
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Legal Business Name | WATERTOWN PEDIATRIC DENTISTRY PLLC
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Dates
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Enumeration Date | 09/10/2025
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Last Update Date | 09/10/2025
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Provider Practice Location Address
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Address Line | 22645 SUMMIT DR
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City | WATERTOWN
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State | NY
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Zip | 13601-7233
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Country | US
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Telephone | 315-221-4044
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Fax |
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Provider Business Mailing Address
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Address Line | 22645 SUMMIT DR
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City | WATERTOWN
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State | NY
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Zip | 13601-7233
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Country | US
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Telephone | 315-221-4044
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Fax |
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | JESSICA BEUTTENMULLER
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Credential |
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Telephone | 315-221-4044
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number |
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License Number State |
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