Provider Demographics
NPI:1861953663
Name:WATTS, CAROLINE MOORE (DMD)
Entity type:Individual
Prefix:MRS
First Name:CAROLINE
Middle Name:MOORE
Last Name:WATTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:CAROLINE
Other - Middle Name:DEBURGH
Other - Last Name:MOORE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5810 LANDING CT
Mailing Address - Street 2:
Mailing Address - City:EMERALD ISLE
Mailing Address - State:NC
Mailing Address - Zip Code:28594-3423
Mailing Address - Country:US
Mailing Address - Phone:404-409-4560
Mailing Address - Fax:
Practice Address - Street 1:988 OCEAN HWY W
Practice Address - Street 2:
Practice Address - City:SUPPLY
Practice Address - State:NC
Practice Address - Zip Code:28462-4060
Practice Address - Country:US
Practice Address - Phone:910-754-7850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-26
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC117741223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No1223G0001XDental ProvidersDentistGeneral Practice