Provider Demographics
NPI:1801938543
Name:WATKINS, STEPHEN NICHOLAS (DDS)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:NICHOLAS
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 1:343 S. STATE ST
Mailing Address - Street 2:
Mailing Address - City:SPARTA
Mailing Address - State:MI
Mailing Address - Zip Code:49345
Mailing Address - Country:US
Mailing Address - Phone:616-887-0131
Mailing Address - Fax:616-887-0155
Practice Address - Street 1:343 S STATE ST
Practice Address - Street 2:
Practice Address - City:SPARTA
Practice Address - State:MI
Practice Address - Zip Code:49345-1731
Practice Address - Country:US
Practice Address - Phone:616-887-0131
Practice Address - Fax:616-887-0155
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010143061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice