Provider Demographics
NPI:1902944911
Name:WATSON, ROBERT COLEMAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:COLEMAN
Last Name:WATSON
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 QUAIL FEATHER TRAIL
Mailing Address - Street 2:
Mailing Address - City:GRIFFIN
Mailing Address - State:GA
Mailing Address - Zip Code:30224
Mailing Address - Country:US
Mailing Address - Phone:770-467-4661
Mailing Address - Fax:
Practice Address - Street 1:1233 EAGLES LANDING PKWY
Practice Address - Street 2:SUITE J
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6399
Practice Address - Country:US
Practice Address - Phone:770-507-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA96681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice