Provider Demographics
NPI:1033935309
Name:KRISTEN K. WATANABE DDS INC
Entity type:Organization
Organization Name:KRISTEN K. WATANABE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:562-943-1055
Mailing Address - Street 1:16315 WHITTIER BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90603-2910
Mailing Address - Country:US
Mailing Address - Phone:562-943-1055
Mailing Address - Fax:
Practice Address - Street 1:16315 WHITTIER BLVD STE 205
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90603-2910
Practice Address - Country:US
Practice Address - Phone:562-943-1055
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-12-02
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental