Provider Demographics
NPI:1831226976
Name:WATKINS, CLIFF PATRICK (DDS)
Entity type:Individual
Prefix:DR
First Name:CLIFF
Middle Name:PATRICK
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:PO BOX 21
Mailing Address - Street 2:
Mailing Address - City:DILLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78017-0021
Mailing Address - Country:US
Mailing Address - Phone:830-965-1696
Mailing Address - Fax:830-965-1696
Practice Address - Street 1:105 EAST MILLER STREET
Practice Address - Street 2:
Practice Address - City:DILLEY
Practice Address - State:TX
Practice Address - Zip Code:78017
Practice Address - Country:US
Practice Address - Phone:830-965-1696
Practice Address - Fax:830-965-1696
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX134221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX091044003Medicaid
TX091044001Medicaid
TX742695794OtherTIN