Provider Demographics
NPI:1780253252
Name:WATSON, SYDNEY SCHAFER
Entity type:Individual
Prefix:
First Name:SYDNEY
Middle Name:SCHAFER
Last Name:WATSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8626 DORCHESTER RD STE 102
Mailing Address - Street 2:
Mailing Address - City:NORTH CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29420-7328
Mailing Address - Country:US
Mailing Address - Phone:843-896-2441
Mailing Address - Fax:
Practice Address - Street 1:8626 DORCHESTER RD STE 102
Practice Address - Street 2:
Practice Address - City:NORTH CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29420-7328
Practice Address - Country:US
Practice Address - Phone:843-896-2441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-21
Last Update Date:2025-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCDGD.9922.GD122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist