MEDICARE: O. ALTON WATSON JR., 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	3252	OK

General Provider Information

NPI Number	:	1306008479
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	O. ALTON WATSON JR., D.D.S.

Provider Business Mailing Address
First Line	:	9202 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6902
Country	:	US
Telephone Number	:	405-692-5551
Fax Number	:	405-692-5558

Provider Business Practice Location Address
First Line	:	9202 S PENNSYLVANIA AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-6902
Country	:	US
Telephone Number	:	405-692-5551
Fax Number	:	405-692-5558

Authorized Official
Title or Position	:	OWNER
Name	:	DR. O. ALTON WATSON JR.
Credential	:	D.D.S.
Telephone Number	:	405-692-5551

Provider Enumeration Date	:	06/30/2008
Last Update Date	:	06/30/2008

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