Provider Demographics
NPI:1336143668
Name:WATSON, CHARLES L (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:L
Last Name:WATSON
Suffix:
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 1:7710 BEECHNUT ST
Mailing Address - Street 2:STE 230
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77074-3107
Mailing Address - Country:US
Mailing Address - Phone:713-774-7012
Mailing Address - Fax:713-774-4103
Practice Address - Street 1:7710 BEECHNUT ST
Practice Address - Street 2:STE 230
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77074-3107
Practice Address - Country:US
Practice Address - Phone:713-774-7012
Practice Address - Fax:713-774-4103
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX83421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice