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General NPI Number Information
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NPI Number | 1871971697
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Entity Type | Organization
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Legal Business Name | SCOTT A WATTERSON DDS, PLLC
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Dates
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Enumeration Date | 05/13/2015
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Last Update Date | 05/13/2015
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Provider Practice Location Address
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Address Line | 1030 LAURENCE AVE, SUITE 3
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City | JACKSON
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State | MI
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Zip | 49202
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Country | US
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Telephone | 517-782-1467
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Fax | 517-782-3659
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Provider Business Mailing Address
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Address Line | 1030 LAURENCE AVE, SUITE 3
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City | JACKSON
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State | MI
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Zip | 49202
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Country | US
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Telephone | 517-782-1467
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Fax | 517-782-3659
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Authorized Official
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Title or Position | DENTIST-OWNER
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Name | MR. SCOTT ALLAN WATTERSON
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Credential | DDS
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Telephone | 517-782-1467
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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 | 2901017509
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License Number State | MI
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