Provider Demographics
NPI:1447462171
Name:WATT, FELICIA (RDH)
Entity type:Individual
Prefix:MS
First Name:FELICIA
Middle Name:
Last Name:WATT
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10716 S KENNETH AVE
Mailing Address - Street 2:
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5344
Mailing Address - Country:US
Mailing Address - Phone:708-424-3068
Mailing Address - Fax:
Practice Address - Street 1:6735 W 95TH ST
Practice Address - Street 2:
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-2112
Practice Address - Country:US
Practice Address - Phone:708-598-0717
Practice Address - Fax:708-598-0813
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist