MEDICARE: WATTS ORTHODONTICS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry

General Provider Information

NPI Number	:	1386227635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATTS ORTHODONTICS

Provider Business Mailing Address
First Line	:	7560 RANGEWOOD DR STE 200
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80920-2100
Country	:	US
Telephone Number	:	719-623-5396
Fax Number	:

Provider Business Practice Location Address
First Line	:	718 MALETA LN STE 200
Second Line	:
City	:	CASTLE ROCK
State	:	CO
Zip	:	80108-7602
Country	:	US
Telephone Number	:	719-596-3113
Fax Number	:	719-325-0244

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CYNDIE LOU PLUID
Credential	:
Telephone Number	:	719-623-5396

Provider Enumeration Date	:	05/04/2021
Last Update Date	:	05/04/2021

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Directions to “WATTS ORTHODONTICS ” Practice Location

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