Provider Demographics
NPI:1164197547
Name:KAWATA, ALLISON (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALLISON
Middle Name:
Last Name:KAWATA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:854 MAGNOLIA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3109
Mailing Address - Country:US
Mailing Address - Phone:951-736-7846
Mailing Address - Fax:
Practice Address - Street 1:854 MAGNOLIA AVE STE A
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3109
Practice Address - Country:US
Practice Address - Phone:951-736-7846
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-09
Last Update Date:2022-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA104732122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist