Organization
DR. SAMUEL L. WATTS D.D.S., M.S., P.A.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PROF. LEILA LANCASTER (OFFICE MANAGER)
(901) 767-6320
Entity
Organization
Contact information
Practice address
5101 SANDERLIN AVE STE 108, MEMPHIS, TN 38117-4363
(901) 767-6320
Mailing address
5101 SANDERLIN AVE STE 108, MEMPHIS, TN 38117-4363
(901) 767-6320
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
3115
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0015173
TENN CARE PROVIDER ID
TN
01
—
012617
TENN CARE PAYEE ID
TN
Enumeration date
12/04/2006
Last updated
08/22/2020
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