Organization
MODERN ORTHODONTICS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SCOTT A. WATTERSON DDS (OWNER/MEMBER)
(517) 206-1445
Entity
Organization
Contact information
Practice address
1030 LAURENCE AVE, STE 4, JACKSON, MI 49202
(517) 888-7338
Mailing address
1030 LAURENCE AVE, STE 4, JACKSON, MI 49202
(517) 888-7338
Taxonomy
Speciality
Code
Description
License number
State
1223X0400X
Orthodontics and Dentofacial Orthopedics Dentistry
Primary
—
—
Other
Enumeration date
10/18/2019
Last updated
10/18/2019
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