MEDICARE: WATSON FAMILY DENTAL LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry
2	261QD0000X	Dental Clinic/Center

General Provider Information

NPI Number	:	1295621399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WATSON FAMILY DENTAL LLC

Provider Business Mailing Address
First Line	:	8564 JEFFERSON HWY STE A
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70809-2424
Country	:	US
Telephone Number	:	225-927-8663
Fax Number	:

Provider Business Practice Location Address
First Line	:	8050 WATSON CIR
Second Line	:
City	:	DENHAM SPRINGS
State	:	LA
Zip	:	70706-1291
Country	:	US
Telephone Number	:	225-927-8663
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL P JUBAN
Credential	:	DDS
Telephone Number	:	225-229-6260

Provider Enumeration Date	:	06/16/2025
Last Update Date	:	06/16/2025

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