Provider Demographics
NPI:1013253236
Name:WATSON, EMILY L (DMD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:L
Last Name:WATSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 PROVIDENT DR
Mailing Address - Street 2:
Mailing Address - City:WARSAW
Mailing Address - State:IN
Mailing Address - Zip Code:46580-3250
Mailing Address - Country:US
Mailing Address - Phone:574-269-3621
Mailing Address - Fax:
Practice Address - Street 1:3837 N HIGH SCHOOL RD STE 12
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46254-2700
Practice Address - Country:US
Practice Address - Phone:317-522-0908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-14
Last Update Date:2014-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011697B122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist