Provider Demographics
NPI:1265654339
Name:WATSON, EVERETT B JR (DDS)
Entity Type:Individual
Prefix:
First Name:EVERETT
Middle Name:B
Last Name:WATSON
Suffix:JR
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 1:8104 WOODWAY DR.
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3804
Mailing Address - Country:US
Mailing Address - Phone:254-772-4514
Mailing Address - Fax:254-772-6271
Practice Address - Street 1:8104 WOODWAY DR.
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3804
Practice Address - Country:US
Practice Address - Phone:254-772-4514
Practice Address - Fax:254-772-6271
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX164681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice