Individual
DAN L WATT
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
150 2ND AVENUE, MELBA, ID 83641
(208) 495-1011
(208) 495-1012
Mailing address
PO BOX 9, 211 16TH AVENUE NORTH, NAMPA, ID 83653-0009
(208) 467-4431
(208) 467-7684
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D3857
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CS10865
CONTROLLED SUBSTANCE REGI
ID
Enumeration date
05/10/2006
Last updated
03/07/2023
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