Individual
DR. AMBER LYNN WATTERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
4805 NE GLISAN ST STE 11N, PORTLAND, OR 97213-2933
(503) 215-1676
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
053820
NY
122300000X
Dentist
D9951
OR
1223X2210X
Orofacial Pain Dentistry
Primary
D9951
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500665882
—
OR
Enumeration date
08/25/2009
Last updated
10/23/2023
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