MEDICARE: JAMES L WATSON JR. 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	0401006877	VA

General Provider Information

NPI Number	:	1659496388
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES L WATSON JR. DDS

Provider Business Mailing Address
First Line	:	703 EAST VIRGINIA BEACH BOULEVARD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-3221
Country	:	US
Telephone Number	:	757-622-3391
Fax Number	:

Provider Business Practice Location Address
First Line	:	703 EAST VIRGINIA BEACH BOULEVARD
Second Line	:
City	:	NORFOLK
State	:	VA
Zip	:	23504-3221
Country	:	US
Telephone Number	:	757-622-3391
Fax Number	:

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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