Provider Demographics
NPI:1831917871
Name:WATKINS DENTISTRY, LLC
Entity type:Organization
Organization Name:WATKINS DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HAVILAND
Authorized Official - Middle Name:JOY
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:812-783-9542
Mailing Address - Street 1:418 S STATE ROAD 57
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47501-4027
Mailing Address - Country:US
Mailing Address - Phone:812-254-7922
Mailing Address - Fax:
Practice Address - Street 1:418 S STATE ROAD 57
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:IN
Practice Address - Zip Code:47501-4027
Practice Address - Country:US
Practice Address - Phone:812-254-7922
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-30
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1316399959Medicaid