MEDICARE: DONALD ROBERT WATTERS D.D.S.

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	1223G0001X	General Practice Dentistry	21664	CA

General Provider Information

NPI Number	:	1710164843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DONALD ROBERT WATTERS D.D.S.

Provider Business Mailing Address
First Line	:	851 FREMONT AVE.
Second Line	:	SUITE 101
City	:	LOS ALTOS
State	:	CA
Zip	:	94024
Country	:	US
Telephone Number	:	650-559-9801
Fax Number	:

Provider Business Practice Location Address
First Line	:	851 FREMONT AVE.
Second Line	:	SUITE 101
City	:	LOS ALTOS
State	:	CA
Zip	:	94024
Country	:	US
Telephone Number	:	650-559-9801
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2008
Last Update Date	:	02/22/2026

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