Provider Demographics
NPI:1770964785
Name:WATKINS, ANDREW PAUL (DDS)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:PAUL
Last Name:WATKINS
Suffix:
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 1:857 S AUTO MALL RD
Mailing Address - Street 2:#4
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47401-5447
Mailing Address - Country:US
Mailing Address - Phone:812-339-4400
Mailing Address - Fax:812-323-2230
Practice Address - Street 1:857 S AUTO MALL RD
Practice Address - Street 2:#4
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47401-5447
Practice Address - Country:US
Practice Address - Phone:812-339-4400
Practice Address - Fax:812-323-2230
Is Sole Proprietor?:No
Enumeration Date:2015-06-16
Last Update Date:2015-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12012291A122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist