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NPI Code Detail

MEDICARE: SANDRA K WATSON RDH

MEDICARE: SANDRA K WATSON RDH
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
1124Q00000XDental HygienistDH8605FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1477154474
Entity Type Code : Individual
Provider Name (Legal Business Name) : SANDRA K WATSON RDH
Provider Business Mailing Address
First Line : PO BOX 796
Second Line :
City : QUINCY
State : FL
Zip : 32353-0796
Country : US
Telephone Number : 850-524-7358
Fax Number :
Provider Business Practice Location Address
First Line : 1249 STRONG RD
Second Line :
City : QUINCY
State : FL
Zip : 32351-5248
Country : US
Telephone Number : 850-875-9502
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2020
Last Update Date : 11/05/2020

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