Individual
JASON T WATKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 925-1675
Mailing address
6226 14TH AVE, KENOSHA, WI 53143-4413
(262) 925-1675
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
6921-016
WI
Other
Enumeration date
12/02/2008
Last updated
12/02/2008
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