Provider Demographics
NPI:1346893484
Name:WATSON, JONI MICHELLE (DDS)
Entity Type:Individual
Prefix:
First Name:JONI
Middle Name:MICHELLE
Last Name:WATSON
Suffix:
Gender:F
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:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:PENNINGTON GAP
Mailing Address - State:VA
Mailing Address - Zip Code:24277-0587
Mailing Address - Country:US
Mailing Address - Phone:276-546-3121
Mailing Address - Fax:
Practice Address - Street 1:128 SOUTH KENTUCKY ST
Practice Address - Street 2:
Practice Address - City:PENNINGTON GAP
Practice Address - State:VA
Practice Address - Zip Code:24277
Practice Address - Country:US
Practice Address - Phone:276-546-3121
Practice Address - Fax:276-546-3636
Is Sole Proprietor?:No
Enumeration Date:2019-07-18
Last Update Date:2021-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014165971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice