Provider Demographics
NPI:1851698484
Name:RYAN WATKINS DDS INC.
Entity Type:Organization
Organization Name:RYAN WATKINS DDS INC.
Other - Org Name:DREAMTIME DENTISTRY DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:805-405-4975
Mailing Address - Street 1:950 VISTA VILLAGE DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92084-6064
Mailing Address - Country:US
Mailing Address - Phone:760-720-0451
Mailing Address - Fax:866-779-9096
Practice Address - Street 1:950 VISTA VILLAGE DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92084-6064
Practice Address - Country:US
Practice Address - Phone:760-274-0993
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-16
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA521301223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPQ8456OtherSAN DIEGO REGIONAL CENTER