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General NPI Number Information
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NPI Number | 1457445231
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Entity Type | Organization
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Legal Business Name | DIANA DO-YABUT AND BRYAN WATANABE DENTAL CORPORATION
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 07/02/2012
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Provider Practice Location Address
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Address Line | 23905 CLINTON KEITH RD STE. 108
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City | WILDOMAR
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State | CA
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Zip | 92595-7897
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Country | US
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Telephone | 951-304-9700
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Fax | 951-304-9711
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Provider Business Mailing Address
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Address Line | 2860 MICHELLE DRIVE 2ND FLOOR
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City | IRVINE
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State | CA
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Zip | 92606-1009
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Country | US
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Telephone | 714-368-2077
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Fax | 714-368-2092
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Authorized Official
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Title or Position | OWNER DDS
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Name | DR. BRYAN K WATANABE
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Credential | DDS
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Telephone | 951-304-9700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 49784
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 37772
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 50080
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 40130
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License Number State | CA
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