Healthcare Provider Details

I. General information

NPI: 1225137573
Provider Name (Legal Business Name): HUYNH AND WATANABE DENTAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 05/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9510 HAGEMAN RD STE. B
BAKERSFIELD CA
93312-3953
US

IV. Provider business mailing address

2860 MICHELLE DRIVE 2ND FLOOR
IRVINE CA
92606-1009
US

V. Phone/Fax

Practice location:
  • Phone: 661-829-2700
  • Fax: 661-829-2770
Mailing address:
  • Phone: 714-845-8890
  • Fax: 714-845-8803

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number40130
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number43860
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number37440
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number49767
License Number StateCA

VIII. Authorized Official

Name: DR. PHI C HUYNH
Title or Position: OWNER DDS
Credential: DMD
Phone: 661-829-2700