Individual
JONATHAN WATERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2935 HIGHWAY 190, MANDEVILLE, LA 70471-3298
(985) 727-7030
Mailing address
4019 VENDOME PL, NEW ORLEANS, LA 70125-3519
(504) 957-7289
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7340
LA
Other
Enumeration date
06/16/2022
Last updated
06/16/2022
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