Provider Demographics
NPI:1518155183
Name:WATSON FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WATSON FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:SABRINA
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:601-922-1171
Mailing Address - Street 1:2189 HENRY HILL DR
Mailing Address - Street 2:STE B
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39204
Mailing Address - Country:US
Mailing Address - Phone:601-922-1171
Mailing Address - Fax:
Practice Address - Street 1:2189 HENRY HILL DR STE B
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39204-2002
Practice Address - Country:US
Practice Address - Phone:601-922-1171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2007-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS3370-06122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty