Individual
DR. GAYLE WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
7728 OLD CANTON ROAD, SUITE A, MADISON, MS 39110
(601) 856-1511
(601) 856-1011
Mailing address
7728 OLD CANTON ROAD, SUITE A, MADISON, MS 39110
(601) 856-1511
(601) 856-1011
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
315800
MS
1223P0221X
Pediatric Dentistry
Primary
3158-00
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00660446
—
MS
Enumeration date
02/05/2007
Last updated
10/24/2018
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