Basic Information
| Provider Information | |||||||||
| NPI: | 1972575645 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WATKINS | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | FRANKLIN | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | III | ||||||||
| Credential: | DENTIST DDS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 W ENT AVE | ||||||||
| Address2: | ATTN 2, DS/SGGD | ||||||||
| City: | PETERSON AFB | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561330 | ||||||||
| FaxNumber: | 7195561331 | ||||||||
| Practice Location | |||||||||
| Address1: | 110 W ENT AVE | ||||||||
| Address2: | ATTN 2, 21DS/SGGD | ||||||||
| City: | PETERSON AFB | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809141540 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195561333 | ||||||||
| FaxNumber: | 7195561331 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/06/2006 | ||||||||
| LastUpdateDate: | 12/05/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 2981 | AL | Y | Dental Providers | Dentist | 122300000X | 17623 | TX | N | Dental Providers | Dentist |
No ID Information.