Provider Demographics
NPI:1427038116
Name:WATKINS, MIALIKA KINYA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIALIKA
Middle Name:KINYA
Last Name:WATKINS
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 1:318 NICOLET DR
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38109-7456
Mailing Address - Country:US
Mailing Address - Phone:901-830-9159
Mailing Address - Fax:
Practice Address - Street 1:1154 S BELLEVUE BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38106-3428
Practice Address - Country:US
Practice Address - Phone:901-775-0870
Practice Address - Fax:901-789-7016
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN78001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN14667OtherTENN CARE ID
TN3205895Medicaid