Organization
MARK N. WATERS, D.D.S, P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MARK NEWTON WATERS D.D.S. (PRESIDENT/DENTIST)
(575) 763-7632
Entity
Organization
Contact information
Practice address
116 W 21ST ST, CLOVIS, NM 88101-4364
(575) 763-7632
(575) 762-4226
Mailing address
116 W 21ST ST, CLOVIS, NM 88101-4364
(575) 763-7632
(575) 762-4226
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DD1426
NM
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
69880832
—
NM
01
—
794219
UNITED CORCORDIA
PA
Enumeration date
04/12/2016
Last updated
04/12/2016
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