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General NPI Number Information
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NPI Number | 1679940647
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Entity Type | Organization
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Legal Business Name | WATSON DENTAL, LLC
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Dates
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Enumeration Date | 08/26/2015
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Last Update Date | 08/26/2015
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Provider Practice Location Address
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Address Line | 11538 W 119TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2002
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Country | US
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Telephone | 913-381-4090
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Fax | 913-381-4419
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Provider Business Mailing Address
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Address Line | 11538 W 119TH ST
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City | OVERLAND PARK
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State | KS
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Zip | 66213-2002
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Country | US
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Telephone | 913-381-4090
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Fax | 913-381-4419
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Authorized Official
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Title or Position | DENTIST
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Name | MRS. LYNDA ROBIN WATSON
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Credential | D.D.S
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Telephone | 913-381-4090
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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 | 6608
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License Number State | KS
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