Provider Demographics
NPI:1831277458
Name:WATKINS, CATHERINE (DDS,MS,PHD)
Entity type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WATKINS
Suffix:
Gender:F
Credentials:DDS,MS,PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3288 ROBINHOOD RD STE 201
Mailing Address - Street 2:
Mailing Address - City:WINSTON SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27106-5464
Mailing Address - Country:US
Mailing Address - Phone:336-659-7700
Mailing Address - Fax:336-659-0037
Practice Address - Street 1:3288 ROBINHOOD RD STE 201
Practice Address - Street 2:
Practice Address - City:WINSTON SALEM
Practice Address - State:NC
Practice Address - Zip Code:27106-5464
Practice Address - Country:US
Practice Address - Phone:336-659-7700
Practice Address - Fax:336-659-0037
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC53461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCNC5346OtherSTATE LICENSE NUMBER
NC8998936Medicaid
NC8998936Medicaid