Individual
MR. PHILIP WESLEY WATKINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
L.D.
Contact information
Practice address
414 SHOUP AVE W, TWIN FALLS, ID 83301-5027
(208) 613-5854
Mailing address
1457 S 2000 E, GOODING, ID 83330-5124
(208) 749-4070
Taxonomy
Speciality
Code
Description
License number
State
122400000X
Denturist
Primary
LD-141
ID
Other
Enumeration date
05/13/2024
Last updated
05/13/2024
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