Provider Demographics
NPI:1609369123
Name:WATSON, ALLIE ELIZABETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLIE
Middle Name:ELIZABETH
Last Name:WATSON
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 1:1514 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-3314
Mailing Address - Country:US
Mailing Address - Phone:318-348-6483
Mailing Address - Fax:
Practice Address - Street 1:414 ROSS ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-9727
Practice Address - Country:US
Practice Address - Phone:318-428-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-09
Last Update Date:2018-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA68841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice