Provider Demographics
NPI:1114028412
Name:WATSON, JR., JAMES GARLAND (DDS, MSD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:GARLAND
Last Name:WATSON, JR.
Suffix:
Gender:M
Credentials:DDS, MSD
Other - Prefix:MS
Other - First Name:PATRICIA
Other - Middle Name:M
Other - Last Name:FACHORN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2400 BROADMOOR DR
Mailing Address - Street 2:
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2801
Mailing Address - Country:US
Mailing Address - Phone:979-776-2114
Mailing Address - Fax:979-776-5259
Practice Address - Street 1:2400 BROADMOOR DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2801
Practice Address - Country:US
Practice Address - Phone:979-776-2114
Practice Address - Fax:979-776-5259
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX78721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics