Provider Demographics
NPI:1295917722
Name:WATTIGNEY, BERT M JR (DDS PA)
Entity type:Individual
Prefix:DR
First Name:BERT
Middle Name:M
Last Name:WATTIGNEY
Suffix:JR
Gender:M
Credentials:DDS PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9964 PINES BLVD
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33024-6139
Mailing Address - Country:US
Mailing Address - Phone:954-432-6222
Mailing Address - Fax:954-432-3815
Practice Address - Street 1:9964 PINES BLVD
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33024-6139
Practice Address - Country:US
Practice Address - Phone:954-432-6222
Practice Address - Fax:954-432-3815
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL76491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice