Provider Demographics
NPI:1376236075
Name:WATSON, PRICE MATTHEW (DMD)
Entity Type:Individual
Prefix:DR
First Name:PRICE
Middle Name:MATTHEW
Last Name:WATSON
Suffix:
Gender:M
Credentials:DMD
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 505
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:SC
Mailing Address - Zip Code:29924-0505
Mailing Address - Country:US
Mailing Address - Phone:803-943-2191
Mailing Address - Fax:803-943-0191
Practice Address - Street 1:202 3RD ST E
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:SC
Practice Address - Zip Code:29924-2512
Practice Address - Country:US
Practice Address - Phone:803-943-2191
Practice Address - Fax:803-943-0191
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.104971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice