Provider Demographics
NPI:1790838225
Name:WATKINOSORIO DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:WATKINOSORIO DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ARNOLD
Authorized Official - Middle Name:
Authorized Official - Last Name:WATKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-423-6165
Mailing Address - Street 1:60 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02110-2510
Mailing Address - Country:US
Mailing Address - Phone:617-423-6165
Mailing Address - Fax:617-426-0006
Practice Address - Street 1:60 FEDERAL ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02110-2510
Practice Address - Country:US
Practice Address - Phone:617-423-6165
Practice Address - Fax:617-426-0006
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA12689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty