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DR. MIRIAM PERDOMO-WATTS DMD
General Practice >> Dentist >> Dental ProvidersRegistrant NPI Number: 1881750446
Individual Registrant:DR. MIRIAM PERDOMO-WATTS DMD
Gender: F
Not Sole Proprietor
Gender: F
Not Sole Proprietor
Location and contact information for practice:
18471 WILTERS STREET ROBERTSDALE, AL 36567 US
Tel: 251-947-3636 Fax: 251-947-3637
Tel: 251-947-3636 Fax: 251-947-3637
Contact information for business:
1121 S MCKENZIE ST FOLEY, AL 36535-1816 US
Tel: 251-233-3246 Fax: --
Tel: 251-233-3246 Fax: --
Registration Information:
NPI: 1881750446
Entity Type: Individual
Entity Type: Individual
Specialty information:
| Primary | Code | Category/Description | State | License Number |
|---|---|---|---|---|
| N | 1223G0001X | Dental Providers Dentist General Practice | GA | 13309 |
| Y | 1223G0001X | Dental Providers Dentist | AL | 5105 |
Legacy codes, insurance codes and state license numbers:
| Issuer | Number | State | Type |
|---|---|---|---|
