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General NPI Number Information
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NPI Number | 1487927216
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Entity Type | Organization
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Legal Business Name | KW BUSINESS ENTERPRISES
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Dates
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Enumeration Date | 02/09/2012
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Last Update Date | 02/09/2012
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Provider Practice Location Address
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Address Line | 3769 SUNSET AVE STE 12 C/O CLEAR 3D IMAGING
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3327
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Country | US
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Telephone | 919-621-5450
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Fax |
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Provider Business Mailing Address
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Address Line | 3769 SUNSET AVE STE 12 C/O CLEAR 3D IMAGING
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City | ROCKY MOUNT
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State | NC
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Zip | 27804-3327
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Country | US
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Telephone | 919-621-5450
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/DENTIST
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Name | DR. MICHAEL S WATSON
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Credential | D.D.S.
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Telephone | 919-621-5450
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6282
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License Number State | NC
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