Provider Demographics
NPI:1750591848
Name:WATSON, TAMARA ROCHELLE (DDS)
Entity type:Individual
Prefix:DR
First Name:TAMARA
Middle Name:ROCHELLE
Last Name:WATSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3310 S SUTTON SQ
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-4721
Mailing Address - Country:US
Mailing Address - Phone:832-512-7912
Mailing Address - Fax:
Practice Address - Street 1:3310 S SUTTON SQ
Practice Address - Street 2:
Practice Address - City:STAFFORD
Practice Address - State:TX
Practice Address - Zip Code:77477-4721
Practice Address - Country:US
Practice Address - Phone:832-512-7912
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX211981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice