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General NPI Number Information
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NPI Number | 1295621399
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Entity Type | Organization
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Legal Business Name | WATSON FAMILY DENTAL LLC
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Dates
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Enumeration Date | 06/16/2025
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Last Update Date | 06/16/2025
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Provider Practice Location Address
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Address Line | 8050 WATSON CIR
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City | DENHAM SPRINGS
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State | LA
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Zip | 70706-1291
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Country | US
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Telephone | 225-927-8663
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Fax |
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Provider Business Mailing Address
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Address Line | 8564 JEFFERSON HWY STE A
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City | BATON ROUGE
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State | LA
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Zip | 70809-2424
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Country | US
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Telephone | 225-927-8663
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MICHAEL P JUBAN
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Credential | DDS
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Telephone | 225-229-6260
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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