Provider Demographics
NPI:1700852472
Name:DR. TONY WATKINS FAMILY DENTISTRY
Entity Type:Organization
Organization Name:DR. TONY WATKINS FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-229-9779
Mailing Address - Street 1:2107 E 12TH AVE
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:KS
Mailing Address - Zip Code:67156-4101
Mailing Address - Country:US
Mailing Address - Phone:620-229-9779
Mailing Address - Fax:620-229-9792
Practice Address - Street 1:2107 E 12TH AVE
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:KS
Practice Address - Zip Code:67156-4101
Practice Address - Country:US
Practice Address - Phone:620-229-9779
Practice Address - Fax:620-229-9792
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS60165122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty