MEDICARE: JASPER N WATTS,DDS,LLC

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	122300000X	Dentist	401005412	VA

General Provider Information

NPI Number	:	1851729685
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASPER N WATTS,DDS,LLC

Provider Business Mailing Address
First Line	:	907 BIG BETHEL RD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1901
Country	:	US
Telephone Number	:	757-838-5999
Fax Number	:	757-838-1431

Provider Business Practice Location Address
First Line	:	907 BIG BETHEL RD
Second Line	:
City	:	HAMPTON
State	:	VA
Zip	:	23666-1901
Country	:	US
Telephone Number	:	757-838-5999
Fax Number	:	757-838-1431

Authorized Official
Title or Position	:	OWNER
Name	:	DR. JASPER N WATTS
Credential	:	DDS
Telephone Number	:	757-838-5999

Provider Enumeration Date	:	10/14/2013
Last Update Date	:	10/14/2013

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