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General NPI Number Information
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NPI Number | 1770850984
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Entity Type | Organization
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Legal Business Name | WATERS FAMILY DENTISTRY, PA
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Dates
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Enumeration Date | 11/17/2011
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Last Update Date | 11/17/2011
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Provider Practice Location Address
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Address Line | 512 REED RD
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City | ANDERSON
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State | SC
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Zip | 29621-2058
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Country | US
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Telephone | 864-226-6278
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Fax | 862-225-1924
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Provider Business Mailing Address
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Address Line | 512 REED RD
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City | ANDERSON
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State | SC
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Zip | 29621-2058
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Country | US
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Telephone | 864-226-6278
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Fax | 862-225-1924
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Authorized Official
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Title or Position | DENTIST
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Name | JOHN M WATERS
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Credential | DMD
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Telephone | 864-226-6278
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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 | 4716
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License Number State | SC
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