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NPI Code Detail

MEDICARE: MARY ELIZABETH WATTS D.D.S.

MEDICARE: MARY ELIZABETH WATTS 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
11223G0001XGeneral Practice Dentistry004078TN

General Provider Information

NPI Number : 1831174945
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ELIZABETH WATTS D.D.S.
Provider Business Mailing Address
First Line : 2413 EVANFIELD CT
Second Line :
City : ANTIOCH
State : TN
Zip : 37013-1900
Country : US
Telephone Number : 615-717-0059
Fax Number : 615-717-2900
Provider Business Practice Location Address
First Line : 927 E BADDOUR PKWY
Second Line :
City : LEBANON
State : TN
Zip : 37087-3706
Country : US
Telephone Number : 615-444-5325
Fax Number : 615-444-2750
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/12/2005
Last Update Date : 12/03/2025

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