Provider Demographics
NPI:1780080713
Name:BENJAMIN T. WATSON, III, DDS, PLC
Entity type:Organization
Organization Name:BENJAMIN T. WATSON, III, DDS, PLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:III
Authorized Official - Credentials:DDS
Authorized Official - Phone:757-873-3322
Mailing Address - Street 1:729 THIMBLE SHOALS BLVD
Mailing Address - Street 2:SUITE 7E
Mailing Address - City:NEWPORT NEWS
Mailing Address - State:VA
Mailing Address - Zip Code:23606-4217
Mailing Address - Country:US
Mailing Address - Phone:757-873-3322
Mailing Address - Fax:757-873-8407
Practice Address - Street 1:729 THIMBLE SHOALS BLVD
Practice Address - Street 2:SUITE 7E
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23606-4217
Practice Address - Country:US
Practice Address - Phone:757-873-3322
Practice Address - Fax:757-873-8407
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ATLANTIC DENTAL CARE, PLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-19
Last Update Date:2014-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04010062221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty