Provider Demographics
NPI:1396295655
Name:WATKINS & MEDURA
Entity type:Organization
Organization Name:WATKINS & MEDURA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:WATKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:570-675-1138
Mailing Address - Street 1:1 TARLETON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:PA
Mailing Address - Zip Code:18612-1248
Mailing Address - Country:US
Mailing Address - Phone:570-675-1138
Mailing Address - Fax:570-675-2152
Practice Address - Street 1:1 TARLETON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:PA
Practice Address - Zip Code:18612-1248
Practice Address - Country:US
Practice Address - Phone:570-675-1138
Practice Address - Fax:570-675-2152
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty