MEDICARE: DR. PRIYANKA WATWE D.D.S.

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	122300000X	Dentist	30.024253	OH
2	122300000X	Dentist	2901022129	MI

General Provider Information

NPI Number	:	1326485079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PRIYANKA WATWE D.D.S.

Provider Business Mailing Address
First Line	:	107 E WASHTENAW ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-1822
Country	:	US
Telephone Number	:	248-880-2445
Fax Number	:

Provider Business Practice Location Address
First Line	:	107 E WASHTENAW ST
Second Line	:
City	:	LANSING
State	:	MI
Zip	:	48933-1822
Country	:	US
Telephone Number	:	248-880-2445
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/03/2013
Last Update Date	:	12/17/2020

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