Provider Demographics
NPI:1023113875
Name:WATERS, DONIHUE (DDS MDS)
Entity type:Individual
Prefix:
First Name:DONIHUE
Middle Name:
Last Name:WATERS
Suffix:
Gender:M
Credentials:DDS MDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9100 WHITE BLUFF RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406
Mailing Address - Country:US
Mailing Address - Phone:912-354-3474
Mailing Address - Fax:912-354-7438
Practice Address - Street 1:9100 WHITE BLUFF RD
Practice Address - Street 2:SUITE 104
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406
Practice Address - Country:US
Practice Address - Phone:912-354-3474
Practice Address - Fax:912-354-7438
Is Sole Proprietor?:No
Enumeration Date:2006-09-14
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0122961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics