Provider Demographics
NPI:1285074260
Name:WATSON, MARCY JO (DDS, DABP)
Entity type:Individual
Prefix:DR
First Name:MARCY
Middle Name:JO
Last Name:WATSON
Suffix:
Gender:F
Credentials:DDS, DABP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4613A BEE CAVES RD
Mailing Address - Street 2:STE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-443-5704
Mailing Address - Fax:
Practice Address - Street 1:4613A BEE CAVES RD
Practice Address - Street 2:STE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-443-5704
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2022-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX350511223P0300X
ORD98891223P0300X, 1223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics