Provider Demographics
NPI:1093784845
Name:WATSON, CRAIG WILLIAM (DDS)
Entity Type:Individual
Prefix:
First Name:CRAIG
Middle Name:WILLIAM
Last Name:WATSON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16801 NEWBURGH RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48154
Mailing Address - Country:US
Mailing Address - Phone:734-464-2400
Mailing Address - Fax:734-464-2403
Practice Address - Street 1:16801 NEWBURGH RD
Practice Address - Street 2:SUITE 110
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48154
Practice Address - Country:US
Practice Address - Phone:734-464-2400
Practice Address - Fax:734-464-2403
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI15276122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist