Provider Demographics
NPI:1710085360
Name:WATSON, DAVID III (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:WATSON
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HALTON VILLAGE CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29607-6833
Mailing Address - Country:US
Mailing Address - Phone:864-335-0505
Mailing Address - Fax:864-335-0508
Practice Address - Street 1:105 HALTON VILLAGE CIR
Practice Address - Street 2:SUITE B
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29607-6833
Practice Address - Country:US
Practice Address - Phone:864-335-0505
Practice Address - Fax:864-335-0508
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6811223X0400X
SC42871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No1223G0001XDental ProvidersDentistGeneral Practice