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General NPI Number Information
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NPI Number | 1871638064
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Entity Type | Individual
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Provider Name | WAYNE G. WATSON D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 02/21/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1539 E PLAZA BLVD
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City | NATIONAL CITY
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State | CA
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Zip | 91950-3641
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Country | US
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Telephone | 619-477-3073
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Fax |
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Provider Business Mailing Address
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Address Line | 2470 AZURE COAST DR
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City | LA JOLLA
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State | CA
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Zip | 92037-3508
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Country | US
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Telephone | 858-455-7144
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 17405
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License Number State | CA
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