Healthcare Provider Details

I. General information

NPI: 1831226976
Provider Name (Legal Business Name): CLIFF PATRICK WATKINS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 12/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 EAST MILLER STREET
DILLEY TX
78017
US

IV. Provider business mailing address

PO BOX 21
DILLEY TX
78017-0021
US

V. Phone/Fax

Practice location:
  • Phone: 830-965-1696
  • Fax: 830-965-1696
Mailing address:
  • Phone: 830-965-1696
  • Fax: 830-965-1696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number13422
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: