# JANE L WATKO DDS PLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1639382450
- **Authorized official:** JANE L WATKO DDS (DENTIST OWNER)
- **Authorized official phone:** (248) 353-8860

## Contact information

- **Practice address:** 20307 W 12 MILE RD, STE \#106, SOUTHFIELD, MI 48076-5407
- **Practice address phone:** (248) 353-8860
- **Practice address fax:** (248) 353-8859
- **Mailing address:** 25994 ELWELL RD, BELLEVILLE, MI 48111-9609
- **Mailing address phone:** (586) 292-5703

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901015874 | MI | Yes |

## Other

- **Enumeration date:** 05/08/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 4232353 | — | MI |