Provider Demographics
NPI:1790881712
Name:WATKINS, JOHN WARREN (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WARREN
Last Name:WATKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3351 PLAINVIEW ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:PASADENA
Mailing Address - State:TX
Mailing Address - Zip Code:77504-1985
Mailing Address - Country:US
Mailing Address - Phone:713-943-0064
Mailing Address - Fax:713-943-1554
Practice Address - Street 1:3351 PLAINVIEW ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:PASADENA
Practice Address - State:TX
Practice Address - Zip Code:77504-1985
Practice Address - Country:US
Practice Address - Phone:713-943-0064
Practice Address - Fax:713-943-1554
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice