Healthcare Provider Details

I. General information

NPI: 1184931552
Provider Name (Legal Business Name): JUSTIN ISAIAH WATSON DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/08/2010
Last Update Date: 07/31/2026
Certification Date: 07/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MCRD PARRIS ISLAND DENTAL BLDG 674 BLVD DE FRANCE
PARRIS ISLAND SC
29905
US

IV. Provider business mailing address

MCRD PARRIS ISLAND DENTAL BLDG 674 BLVD DE FRANCE
PARRIS ISLAND SC
29905
US

V. Phone/Fax

Practice location:
  • Phone: 843-228-5994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDE 60163760
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: