Provider Demographics
NPI:1902535354
Name:WATSON, JOHN RYAN (DMD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:RYAN
Last Name:WATSON
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 DRESSAGE CT
Mailing Address - Street 2:
Mailing Address - City:HOCKESSIN
Mailing Address - State:DE
Mailing Address - Zip Code:19707-2505
Mailing Address - Country:US
Mailing Address - Phone:302-824-8484
Mailing Address - Fax:
Practice Address - Street 1:511 N PROVIDENCE RD
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2599
Practice Address - Country:US
Practice Address - Phone:610-565-0525
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-09
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0436141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice