Provider Demographics
NPI:1659252104
Name:WATERTOWN PEDIATRIC DENTISTRY PLLC
Entity type:Organization
Organization Name:WATERTOWN PEDIATRIC DENTISTRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEUTTENMULLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-221-4044
Mailing Address - Street 1:22645 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-7233
Mailing Address - Country:US
Mailing Address - Phone:315-221-4044
Mailing Address - Fax:
Practice Address - Street 1:22645 SUMMIT DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-7233
Practice Address - Country:US
Practice Address - Phone:315-221-4044
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-10
Last Update Date:2025-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty