Provider Demographics
NPI:1457339194
Name:WATSON, WILLIAM R JR (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12528 WARWICK BLVD STE D
Mailing Address - Street 2:
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-2958
Mailing Address - Country:US
Mailing Address - Phone:757-599-8393
Mailing Address - Fax:757-599-8307
Practice Address - Street 1:12528 WARWICK BLVD STE D
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-2958
Practice Address - Country:US
Practice Address - Phone:757-599-8393
Practice Address - Fax:757-599-8307
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-04
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS6545122300000X
VA04014160411223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty
No122300000XDental ProvidersDentist