Provider Demographics
NPI:1306940713
Name:WATSON, MICHAEL J (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:J
Last Name:WATSON
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 1:4465 S 900 E STE 175
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-2644
Mailing Address - Country:US
Mailing Address - Phone:801-278-0704
Mailing Address - Fax:801-278-6648
Practice Address - Street 1:4465 S 900 E STE 175
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-2644
Practice Address - Country:US
Practice Address - Phone:801-278-0704
Practice Address - Fax:801-278-6648
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-08
Last Update Date:2020-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT870669329122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist