Provider Demographics
NPI:1104939206
Name:WATKINS, THOMAS RICHARD (DDS)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RICHARD
Last Name:WATKINS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7614 CULEBRA RD STE 103
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78251-1477
Mailing Address - Country:US
Mailing Address - Phone:210-523-0000
Mailing Address - Fax:210-523-0067
Practice Address - Street 1:7614 CULEBRA RD STE 103
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-1477
Practice Address - Country:US
Practice Address - Phone:210-523-0000
Practice Address - Fax:210-523-0067
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12519122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist