Healthcare Provider Details

I. General information

NPI: 1336293059
Provider Name (Legal Business Name): ROBERT B WATKINS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 WOOLSEY ST STE 112
BERKELEY CA
94705-1974
US

IV. Provider business mailing address

2320 WOOLSEY ST STE 112
BERKELEY CA
94705-1974
US

V. Phone/Fax

Practice location:
  • Phone: 510-845-1505
  • Fax: 510-845-0923
Mailing address:
  • Phone: 510-845-1505
  • Fax: 510-845-0923

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number34656
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: