Provider Demographics
NPI:1366854986
Name:WATSON, JAMES MATHEW JR (DDS)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:MATHEW
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 1:291 RENNER PKWY STE A
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-1342
Mailing Address - Country:US
Mailing Address - Phone:972-234-0626
Mailing Address - Fax:
Practice Address - Street 1:291 RENNER PKWY STE A
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-1342
Practice Address - Country:US
Practice Address - Phone:972-234-0626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-02
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX29955122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist