Provider Demographics
NPI:1891204616
Name:WATKINS DENTAL GROUP LLC
Entity Type:Organization
Organization Name:WATKINS DENTAL GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:KEARNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-675-1138
Mailing Address - Street 1:1 TARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612
Mailing Address - Country:US
Mailing Address - Phone:570-675-1138
Mailing Address - Fax:571-675-2152
Practice Address - Street 1:1 TARLETON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612
Practice Address - Country:US
Practice Address - Phone:570-675-1138
Practice Address - Fax:571-675-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-25
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty