Provider Demographics
NPI:1316399959
Name:WATKINS, HAVILAND JOY (DMD)
Entity Type:Individual
Prefix:DR
First Name:HAVILAND
Middle Name:JOY
Last Name:WATKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:HAVILAND
Other - Middle Name:JOY
Other - Last Name:AYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:202 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:HUNTINGBURG
Mailing Address - State:IN
Mailing Address - Zip Code:47542-9565
Mailing Address - Country:US
Mailing Address - Phone:812-683-2006
Mailing Address - Fax:812-683-5162
Practice Address - Street 1:202 E 17TH ST
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9565
Practice Address - Country:US
Practice Address - Phone:812-683-2006
Practice Address - Fax:812-683-5162
Is Sole Proprietor?:No
Enumeration Date:2016-07-07
Last Update Date:2018-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012532A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201373870Medicaid