Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0001X | Dental Public Health | DS2608 | TN |
NPI | 1184613176 |
---|---|
Provider Name | Dr. William Watson |
First Address | Memphis, TN 38105-5041 |
Second Address | Memphis, TN 38105-5041 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/10/2005 |
Last Update Date | 08/07/2007 |