Provider Demographics
NPI:1942387071
Name:MCDUFFIE-WATSON, JAMEL N (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMEL
Middle Name:N
Last Name:MCDUFFIE-WATSON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6104 FAYETTEVILLE RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-6283
Mailing Address - Country:US
Mailing Address - Phone:919-484-7478
Mailing Address - Fax:919-572-9942
Practice Address - Street 1:6104 FAYETTEVILLE RD
Practice Address - Street 2:SUITE 107
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-6283
Practice Address - Country:US
Practice Address - Phone:919-484-7478
Practice Address - Fax:919-572-9942
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC67701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC899010WMedicaid