Provider Demographics
NPI:1972777035
Name:DRS LINVILLE & WATSON
Entity Type:Organization
Organization Name:DRS LINVILLE & WATSON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:LINVILLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:252-237-5124
Mailing Address - Street 1:603 W NASH ST
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3059
Mailing Address - Country:US
Mailing Address - Phone:252-237-5124
Mailing Address - Fax:252-237-1530
Practice Address - Street 1:603 W NASH ST
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3059
Practice Address - Country:US
Practice Address - Phone:252-237-5124
Practice Address - Fax:252-237-1530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-18
Last Update Date:2008-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC24811223G0001X
NC82021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty