MEDICARE: DR. RYAN PATRICK 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	52130	CA
2	1223D0004X	Dental Anesthesiology	52130	CA

General Provider Information

NPI Number	:	1104954999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RYAN PATRICK WATKINS D.D.S.

Provider Business Mailing Address
First Line	:	2615 VIA ECO
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92010-8348
Country	:	US
Telephone Number	:	805-405-4975
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 VISTA VILLAGE DR
Second Line	:
City	:	VISTA
State	:	CA
Zip	:	92084-6064
Country	:	US
Telephone Number	:	760-274-0993
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	10/27/2023

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