Provider Demographics
NPI:1083863435
Name:WATSON, RANDAL L (DDS, PA)
Entity Type:Individual
Prefix:
First Name:RANDAL
Middle Name:L
Last Name:WATSON
Suffix:
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 1:13809 RESEARCH BLVD
Mailing Address - Street 2:SUITE 804
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-1241
Mailing Address - Country:US
Mailing Address - Phone:512-331-0001
Mailing Address - Fax:512-219-0152
Practice Address - Street 1:13809 RESEARCH BLVD
Practice Address - Street 2:SUITE 804
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-1241
Practice Address - Country:US
Practice Address - Phone:512-331-0001
Practice Address - Fax:512-219-0152
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2008-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20590122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist