Provider Demographics
NPI:1922391630
Name:WATKINS-TARVER, MARGARETTA EARLISA (DMD)
Entity type:Individual
Prefix:DR
First Name:MARGARETTA
Middle Name:EARLISA
Last Name:WATKINS-TARVER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:MARGARETTA
Other - Middle Name:WATKINS
Other - Last Name:TARVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DMD
Mailing Address - Street 1:5830 MILLSTONE RUN
Mailing Address - Street 2:
Mailing Address - City:STONE MOUNTAIN
Mailing Address - State:GA
Mailing Address - Zip Code:30087-1827
Mailing Address - Country:US
Mailing Address - Phone:404-451-5690
Mailing Address - Fax:
Practice Address - Street 1:5830 MILLSTONE RUN
Practice Address - Street 2:
Practice Address - City:STONE MOUNTAIN
Practice Address - State:GA
Practice Address - Zip Code:30087-1827
Practice Address - Country:US
Practice Address - Phone:404-451-5690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-27
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139651223P0221X
NYP707131223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry