# WATAUGA DENTAL CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114118130
- **Authorized official:** DR. CLAYTON EDWARD DAVIS D.D.S. (MANAGER)
- **Authorized official phone:** (423) 247-7741

## Contact information

- **Practice address:** 613 WATAUGA ST, SUITES C, D & E, KINGSPORT, TN 37660-4429
- **Practice address phone:** (423) 247-7741
- **Practice address fax:** (423) 247-7441
- **Mailing address:** 613 WATAUGA ST, SUITE E, KINGSPORT, TN 37660-4429
- **Mailing address phone:** (423) 247-7741
- **Mailing address fax:** (423) 247-7441

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | — | NULL | Yes |
| 1223G0001X | General Practice Dentistry | — | — | Yes |

## Other

- **Enumeration date:** 08/05/2007
- **Last updated:** 07/06/2023

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 5442136 | — | TN |