Provider Demographics
NPI:1497836191
Name:WATSON, BRAILLE MARIE (DMD)
Entity type:Individual
Prefix:DR
First Name:BRAILLE
Middle Name:MARIE
Last Name:WATSON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 NELSON AVE
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32935-6743
Mailing Address - Country:US
Mailing Address - Phone:352-207-6863
Mailing Address - Fax:321-259-2728
Practice Address - Street 1:17 NELSON AVE
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-6743
Practice Address - Country:US
Practice Address - Phone:321-259-2161
Practice Address - Fax:321-259-2728
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2021-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN160931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice