Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 17664 | TX |
NPI | 1073635637 |
---|---|
Provider Name | Dr. Stephen C. Watson JR. |
First Address | Sugar Land, TX 77479-3149 |
Second Address | Sugar Land, TX 77479-3149 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2007 |
Last Update Date | 08/07/2007 |