Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | 10459 | AZ |
NPI | 1659835817 |
---|---|
Provider Name | Caitlin Meredith Waters |
First Address | Phoenix, AZ 85012-1438 |
Second Address | Phoenix, AZ 85012-1438 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/01/2019 |
Last Update Date | 30/08/2021 |