Provider Demographics
NPI:1316086184
Name:WATSON, COLLEEN A (DDS)
Entity type:Individual
Prefix:
First Name:COLLEEN
Middle Name:A
Last Name:WATSON
Suffix:
Gender:F
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:PO BOX 66
Mailing Address - Street 2:107 BANNON AVE
Mailing Address - City:BUCHANAN
Mailing Address - State:NY
Mailing Address - Zip Code:10511
Mailing Address - Country:US
Mailing Address - Phone:914-737-2869
Mailing Address - Fax:914-788-7161
Practice Address - Street 1:107 BANNON AVE
Practice Address - Street 2:
Practice Address - City:BUCHANAN
Practice Address - State:NY
Practice Address - Zip Code:10511
Practice Address - Country:US
Practice Address - Phone:914-737-2869
Practice Address - Fax:914-788-7161
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045827122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist