| NPI | 1740389162 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BRYAN K WATANABE Owner Dds 951-658-9980 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: CA 40130) |
| Additional Taxonomies | 1223P0300X Dentist Periodontics (Licence: CA 37772) |
| 1223S0112X Dentist Oral and Maxillofacial Surgery (Licence: CA 53124) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 51049) | |
| 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: CA 49975) | |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2012-06-04 |