Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 0401008205 | VA |
NPI | 1417927286 |
---|---|
Provider Name | Dr. Dale Vickers Watkins JR. |
First Address | Portsmouth, VA 23708-2111 |
Second Address | Portsmouth, VA 23708-2111 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2006 |
Last Update Date | 10/07/2007 |