Provider Demographics
NPI:1972026847
Name:JAMES WATSON DDS PLLC
Entity Type:Organization
Organization Name:JAMES WATSON DDS PLLC
Other - Org Name:JAMES WATSON DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/EMPLOYEE
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:248-355-9800
Mailing Address - Street 1:4850 BRIARWOOD AVE # CONDO8
Mailing Address - Street 2:
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-1355
Mailing Address - Country:US
Mailing Address - Phone:734-649-5200
Mailing Address - Fax:
Practice Address - Street 1:20307 W 12 MILE RD STE 106
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48076-5407
Practice Address - Country:US
Practice Address - Phone:248-355-9800
Practice Address - Fax:248-355-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI16288261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
1346456217OtherMY NPI TYPE 1