MEDICARE: DR. WILLIAM EDWARD WATKINS DDS

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	DS016293-L	PA

General Provider Information

NPI Number	:	1063410686
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM EDWARD WATKINS DDS

Provider Business Mailing Address
First Line	:	BACK MT. PROF. BLDG, 1 TUNKHANNOCK HWY.
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612
Country	:	US
Telephone Number	:	570-675-1138
Fax Number	:	570-675-2152

Provider Business Practice Location Address
First Line	:	BACK MT. PROF. BLDG.,TUNKHANNOCK HIGHWAY
Second Line	:
City	:	DALLAS
State	:	PA
Zip	:	18612
Country	:	US
Telephone Number	:	570-675-1138
Fax Number	:	570-675-2152

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

Provider Enumeration Date	:	07/08/2005
Last Update Date	:	07/08/2007

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