Provider Demographics
NPI:1265528277
Name:WATSON, MOSES III (DDS)
Entity type:Individual
Prefix:
First Name:MOSES
Middle Name:
Last Name:WATSON
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S KING ST
Mailing Address - Street 2:
Mailing Address - City:LAURINBURG
Mailing Address - State:NC
Mailing Address - Zip Code:28352-3704
Mailing Address - Country:US
Mailing Address - Phone:910-276-9688
Mailing Address - Fax:910-276-2150
Practice Address - Street 1:426 S KING ST
Practice Address - Street 2:
Practice Address - City:LAURINBURG
Practice Address - State:NC
Practice Address - Zip Code:28352-3704
Practice Address - Country:US
Practice Address - Phone:910-276-9688
Practice Address - Fax:910-276-2150
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC61841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998941Medicaid
NC89902VMMedicaid