Provider Demographics
NPI:1235408667
Name:HEBRON FAMILY DENTISTRY - VALERIE WATSON DDS LLC
Entity Type:Organization
Organization Name:HEBRON FAMILY DENTISTRY - VALERIE WATSON DDS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VALERIE
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:859-689-2021
Mailing Address - Street 1:2940 HEBRON PARK DR
Mailing Address - Street 2:104
Mailing Address - City:HEBRON
Mailing Address - State:KY
Mailing Address - Zip Code:41048-9534
Mailing Address - Country:US
Mailing Address - Phone:859-689-2021
Mailing Address - Fax:
Practice Address - Street 1:2940 HEBRON PARK DR
Practice Address - Street 2:104
Practice Address - City:HEBRON
Practice Address - State:KY
Practice Address - Zip Code:41048-9534
Practice Address - Country:US
Practice Address - Phone:859-689-2021
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-13
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY84361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty