Provider Demographics
NPI:1982718334
Name:WATTS, EDMOND THOMAS (DDS)
Entity type:Individual
Prefix:DR
First Name:EDMOND
Middle Name:THOMAS
Last Name:WATTS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:666 N FIELDER RD
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76012-3803
Mailing Address - Country:US
Mailing Address - Phone:817-261-9772
Mailing Address - Fax:817-459-1783
Practice Address - Street 1:666 N FIELDER RD
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76012-3803
Practice Address - Country:US
Practice Address - Phone:817-261-9772
Practice Address - Fax:817-459-1783
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX180701223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry