Organization
JANE L WATKO DDS PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JANE L WATKO DDS (DENTIST OWNER)
(248) 353-8860
Entity
Organization
Contact information
Practice address
20307 W 12 MILE RD, STE #106, SOUTHFIELD, MI 48076-5407
(248) 353-8860
(248) 353-8859
Mailing address
25994 ELWELL RD, BELLEVILLE, MI 48111-9609
(586) 292-5703
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901015874
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4232353
—
MI
Enumeration date
05/08/2007
Last updated
08/22/2020
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