Healthcare Provider Details

I. General information

NPI: 1669582425
Provider Name (Legal Business Name): JAMES EDWARD WATSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

156 WEST PORTAL AVE
SAN FRANCISCO CA
94127
US

IV. Provider business mailing address

156 WEST PORTAL AVE
SAN FRANCISCO CA
94127
US

V. Phone/Fax

Practice location:
  • Phone: 415-564-7200
  • Fax: 415-564-0180
Mailing address:
  • Phone: 415-564-7200
  • Fax: 415-564-0180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD22188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: