Provider Demographics
NPI:1114194818
Name:KEITH E WATSON DDS PC
Entity Type:Organization
Organization Name:KEITH E WATSON DDS PC
Other - Org Name:NORTH PORTLAND DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:503-235-3002
Mailing Address - Street 1:1832 N LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97217-5662
Mailing Address - Country:US
Mailing Address - Phone:503-235-3002
Mailing Address - Fax:503-235-0084
Practice Address - Street 1:1832 N LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97217-5662
Practice Address - Country:US
Practice Address - Phone:503-235-3002
Practice Address - Fax:503-235-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-12
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR82201223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty