MEDICARE: DR. MICHAEL TODD WATKINS D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	2901014777	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	2901014777	OTHER	MI	DENTAL LICENSE ID NUMBER

General Provider Information

NPI Number	:	1043229917
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL TODD WATKINS D.D.S.

Provider Business Mailing Address
First Line	:	52 S. MAIN ST.
Second Line	:	P.O. BOX 300
City	:	KENT CITY
State	:	MI
Zip	:	49330
Country	:	US
Telephone Number	:	616-678-4040
Fax Number	:	616-678-5194

Provider Business Practice Location Address
First Line	:	52 S. MAIN ST.
Second Line	:	SUITE A
City	:	KENT CITY
State	:	MI
Zip	:	49330
Country	:	US
Telephone Number	:	616-678-4040
Fax Number	:	616-678-5194

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2006
Last Update Date	:	07/08/2007

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