Provider Demographics
NPI:1447546320
Name:WATSON, DIANNE BLANTON (DDS)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:BLANTON
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 1:401 DEERY ST
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-3405
Mailing Address - Country:US
Mailing Address - Phone:931-684-1882
Mailing Address - Fax:931-684-1883
Practice Address - Street 1:401 DEERY ST
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-3405
Practice Address - Country:US
Practice Address - Phone:931-684-1882
Practice Address - Fax:931-684-1883
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS0000005253122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist