Provider Demographics
NPI:1871688671
Name:WATKINS, WILLIAM TEDFORD (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:TEDFORD
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 1:751 S BASCOM AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2604
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20480 BLAUER DR
Practice Address - Street 2:# D
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070-4371
Practice Address - Country:US
Practice Address - Phone:408-867-9474
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA317291223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV02452Medicare UPIN
CADS0317290Medicare PIN