Provider Demographics
NPI:1902642549
Name:WATTS, VICTORIA (DMD)
Entity type:Individual
Prefix:DR
First Name:VICTORIA
Middle Name:
Last Name:WATTS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 536
Mailing Address - Street 2:
Mailing Address - City:WOOTON
Mailing Address - State:KY
Mailing Address - Zip Code:41776-0536
Mailing Address - Country:US
Mailing Address - Phone:606-538-5474
Mailing Address - Fax:
Practice Address - Street 1:116 VETERANS DR
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-9483
Practice Address - Country:US
Practice Address - Phone:606-439-0577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-03
Last Update Date:2024-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY11139122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist