Provider Demographics
NPI:1598945511
Name:CHRISTOPHER R WATERS DDS PC
Entity type:Organization
Organization Name:CHRISTOPHER R WATERS DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:R
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:308-382-1734
Mailing Address - Street 1:2916 W STOLLEY PARK RD
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68801
Mailing Address - Country:US
Mailing Address - Phone:308-382-1734
Mailing Address - Fax:308-382-1784
Practice Address - Street 1:2916 W STOLLEY PARK RD
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68801
Practice Address - Country:US
Practice Address - Phone:308-382-1734
Practice Address - Fax:308-382-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-07
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE07816OtherBLUECROSS/BLUESHIELD
NE07816OtherBLUECROSS/BLUESHIELD