Individual provider Active NPI

Ryan Patrick Watkins, D.D.S.

  • Dental Anesthesiology
  • Vista, CA
National Provider Identifier
1104954999
Registry record updated Oct 27, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental AnesthesiologyTaxonomy code 1223D0004X
License
52130 Issued in CA
Practice address
950 Vista Village Dr
Vista, CA 92084-6064
Phone
(760) 274-0993
NPI assigned
Mar 1, 2007
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 27, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Dentistry 1223G0001X 52130 CA
Dental Anesthesiology 1223D0004X 52130 CA Primary

Addresses

Primary practice location

950 Vista Village Dr
Vista, CA 92084-6064

Mailing address

2615 Via Eco
Carlsbad, CA 92010-8348
Phone (805) 405-4975

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20160621000774 CA Order and Referring Only - DentistPractitioner - Dentist 2466743554

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Ryan Watkins DDS Inc. General Practice CurrentSince Oct 29, 2023 Accepting new patients

Locations

3039 Jefferson St
Ste A
Carlsbad, CA 92008
Phone (805) 405-4975

950 Vista Village Dr
Vista, CA 92084
Phone (760) 274-0993

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1698364800000",
    "number": "1104954999",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2615 VIA ECO",
            "city": "CARLSBAD",
            "state": "CA",
            "postal_code": "920108348",
            "telephone_number": "805-405-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "950 VISTA VILLAGE DR",
            "city": "VISTA",
            "state": "CA",
            "postal_code": "920846064",
            "telephone_number": "760-274-0993"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATKINS",
        "first_name": "RYAN",
        "middle_name": "PATRICK",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-01",
        "last_updated": "2023-10-27",
        "certification_date": "2023-10-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "52130",
            "primary": false
        },
        {
            "code": "1223D0004X",
            "taxonomy_group": "",
            "desc": "Dentist, Dental Anesthesiology",
            "state": "CA",
            "license": "52130",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Vista, CA

Sources for this page

Verify at the official NPI Registry.