MEDICARE: DR. JOSEPH WATSON 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	122300000X	Dentist	019-023258	IL

General Provider Information

NPI Number	:	1861481053
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH WATSON D.D.S.

Provider Business Mailing Address
First Line	:	1951 E 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-4632
Country	:	US
Telephone Number	:	773-221-4071
Fax Number	:	773-221-9602

Provider Business Practice Location Address
First Line	:	1951 E 79TH ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60649-4632
Country	:	US
Telephone Number	:	773-221-4071
Fax Number	:	773-221-9602

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

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	02/06/2012

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