Provider Demographics
NPI:1932313269
Name:WATKINS, TERESA MICHELLE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:MICHELLE
Last Name:WATKINS
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:MUNCIE
Mailing Address - State:IN
Mailing Address - Zip Code:47305-1634
Mailing Address - Country:US
Mailing Address - Phone:765-282-2265
Mailing Address - Fax:765-282-2266
Practice Address - Street 1:315 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:MUNCIE
Practice Address - State:IN
Practice Address - Zip Code:47305-1634
Practice Address - Country:US
Practice Address - Phone:765-282-2265
Practice Address - Fax:765-282-2266
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12010271A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist