Provider Demographics
NPI:1306008479
Name:O. ALTON WATSON JR., D.D.S.
Entity Type:Organization
Organization Name:O. ALTON WATSON JR., D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:O.
Authorized Official - Middle Name:ALTON
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-692-5551
Mailing Address - Street 1:9202 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6902
Mailing Address - Country:US
Mailing Address - Phone:405-692-5551
Mailing Address - Fax:405-692-5558
Practice Address - Street 1:9202 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6902
Practice Address - Country:US
Practice Address - Phone:405-692-5551
Practice Address - Fax:405-692-5558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2008-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK32521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty