Provider Demographics
NPI:1841392404
Name:WATKIN, CHARLES OTTO (DDS)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:OTTO
Last Name:WATKIN
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 1:3076 SHOREWOOD LN
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:55113-1401
Mailing Address - Country:US
Mailing Address - Phone:651-633-3443
Mailing Address - Fax:
Practice Address - Street 1:1399 GENEVA AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:OAKDALE
Practice Address - State:MN
Practice Address - Zip Code:55128-5709
Practice Address - Country:US
Practice Address - Phone:651-731-6464
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN94711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice