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General NPI Number Information
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NPI Number | 1780056135
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Entity Type | Organization
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Legal Business Name | BRYAN WATANABE DDS LIBERTY DENTAL GROUP PC
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Dates
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Enumeration Date | 10/26/2015
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Last Update Date | 10/26/2015
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Provider Practice Location Address
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Address Line | 8291 N BOOTH AVENUE
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City | KANSAS CITY
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State | MO
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Zip | 64158
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Country | US
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Telephone | 816-728-2979
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Fax | 816-415-3286
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Provider Business Mailing Address
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Address Line | 17000 RED HILL AVE
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City | IRVINE
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State | CA
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Zip | 92614-5626
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Country | US
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Telephone | 714-845-8890
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Fax | 949-474-1495
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Authorized Official
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Title or Position | OWNER
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Name | DR. BRYAN K WATANABE
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Credential | DDS
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Telephone | 816-728-2979
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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 |
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License Number State |
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