Healthcare Provider Details

I. General information

NPI: 1215862362
Provider Name (Legal Business Name): TODD CHANDLER WATSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 N WOODRUFF AVE
IDAHO FALLS ID
83401-4334
US

IV. Provider business mailing address

130 CASTLEROCK LN
IDAHO FALLS ID
83404-8441
US

V. Phone/Fax

Practice location:
  • Phone: 208-529-0120
  • Fax:
Mailing address:
  • Phone: 435-720-3087
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number3381812
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: