Provider Demographics
NPI:1457486565
Name:WATKINS, SHERYL LEA (DMD)
Entity Type:Individual
Prefix:DR
First Name:SHERYL
Middle Name:LEA
Last Name:WATKINS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:SHERI
Other - Middle Name:L
Other - Last Name:WATKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 1290
Mailing Address - Street 2:
Mailing Address - City:LABELLE
Mailing Address - State:FL
Mailing Address - Zip Code:33975-1290
Mailing Address - Country:US
Mailing Address - Phone:239-768-9010
Mailing Address - Fax:863-674-0899
Practice Address - Street 1:367 W HICKPOOCHEE AVE
Practice Address - Street 2:
Practice Address - City:LABELLE
Practice Address - State:FL
Practice Address - Zip Code:33935-4761
Practice Address - Country:US
Practice Address - Phone:863-674-0799
Practice Address - Fax:863-674-0899
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN00138351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice