Provider Demographics
NPI:1588625420
Name:WATKINS, IRIS (DDS)
Entity type:Individual
Prefix:MISS
First Name:IRIS
Middle Name:
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 1:5609 TRABUE RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-9567
Mailing Address - Country:US
Mailing Address - Phone:614-851-3295
Mailing Address - Fax:614-851-3297
Practice Address - Street 1:5609 TRABUE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-9567
Practice Address - Country:US
Practice Address - Phone:614-851-3295
Practice Address - Fax:614-851-3297
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-30
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30020133122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2018980Medicaid