Healthcare Provider Details

I. General information

NPI: 1972575645
Provider Name (Legal Business Name): JOHN FRANKLIN WATKINS III DENTIST DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2006
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 W ENT AVE ATTN 2, 21DS/SGGD
PETERSON AFB CO
80914-1540
US

IV. Provider business mailing address

110 W ENT AVE ATTN 2, DS/SGGD
PETERSON AFB CO
80914-1540
US

V. Phone/Fax

Practice location:
  • Phone: 719-556-1333
  • Fax: 719-556-1331
Mailing address:
  • Phone: 719-556-1330
  • Fax: 719-556-1331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2981
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number17623
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: