Provider Demographics
NPI:1205433760
Name:ROBERT R. WATTS, DDS, PLLC
Entity type:Organization
Organization Name:ROBERT R. WATTS, DDS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:517-655-2993
Mailing Address - Street 1:1284 W GRAND RIVER AVE
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTON
Mailing Address - State:MI
Mailing Address - Zip Code:48895-9374
Mailing Address - Country:US
Mailing Address - Phone:517-655-2993
Mailing Address - Fax:517-655-1380
Practice Address - Street 1:1284 W GRAND RIVER AVE
Practice Address - Street 2:
Practice Address - City:WILLIAMSTON
Practice Address - State:MI
Practice Address - Zip Code:48895-9374
Practice Address - Country:US
Practice Address - Phone:517-655-2993
Practice Address - Fax:517-655-1380
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-07
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1659459725OtherNPI