Individual
DR. ETHEL LEA WATSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
6828 COMMERCE ST, SUITE 104, SPRINGFIELD, VA 22150-2639
(703) 752-2500
(703) 752-2503
Mailing address
6828 COMMERCE ST, SUITE 104, SPRINGFIELD, VA 22150-2639
(703) 752-2500
(703) 752-2503
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
0401006841
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010111463
—
VA
Enumeration date
03/24/2006
Last updated
07/08/2007
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