Provider Demographics
NPI:1487927216
Name:KW BUSINESS ENTERPRISES
Entity type:Organization
Organization Name:KW BUSINESS ENTERPRISES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:S
Authorized Official - Last Name:WATSON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:919-621-5450
Mailing Address - Street 1:3769 SUNSET AVE STE 12
Mailing Address - Street 2:C/O CLEAR 3D IMAGING
Mailing Address - City:ROCKY MOUNT
Mailing Address - State:NC
Mailing Address - Zip Code:27804-3327
Mailing Address - Country:US
Mailing Address - Phone:919-621-5450
Mailing Address - Fax:
Practice Address - Street 1:3769 SUNSET AVE STE 12
Practice Address - Street 2:C/O CLEAR 3D IMAGING
Practice Address - City:ROCKY MOUNT
Practice Address - State:NC
Practice Address - Zip Code:27804-3327
Practice Address - Country:US
Practice Address - Phone:919-621-5450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC6282122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8998922Medicaid