Provider Demographics
NPI:1831178011
Name:WATSON, TERRY L (DMD)
Entity type:Individual
Prefix:DR
First Name:TERRY
Middle Name:L
Last Name:WATSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 23RD AVE N
Mailing Address - Street 2:SUITE 101
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1525
Mailing Address - Country:US
Mailing Address - Phone:615-320-3210
Mailing Address - Fax:615-329-8931
Practice Address - Street 1:310 23RD AVE N
Practice Address - Street 2:SUITE 101
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37203-1525
Practice Address - Country:US
Practice Address - Phone:615-320-3210
Practice Address - Fax:615-329-8931
Is Sole Proprietor?:No
Enumeration Date:2006-01-16
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR31861223G0001X
TN89321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR883850OtherUNITED CONCORDIA PROVIDER
AR134741608Medicaid
AR5T381OtherFEDERAL BCBS
AR710854906OtherPROVIDER ID NUMBER
AR710854906OtherPROVIDER ID NUMBER