Healthcare Provider Details

I. General information

NPI: 1558093989
Provider Name (Legal Business Name): BRETT WATANABE DDS, MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2022
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE # S738
SAN FRANCISCO CA
94143-2205
US

IV. Provider business mailing address

110 CHANNEL ST UNIT 421
SAN FRANCISCO CA
94158-1750
US

V. Phone/Fax

Practice location:
  • Phone: 408-335-3651
  • Fax:
Mailing address:
  • Phone: 408-335-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDDS108056
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDDS108056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: