Provider Demographics
NPI:1225137573
Name:HUYNH AND WATANABE DENTAL CORPORATION
Entity Type:Organization
Organization Name:HUYNH AND WATANABE DENTAL CORPORATION
Other - Org Name:RIVER LAKES DENTAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:PHI
Authorized Official - Middle Name:C
Authorized Official - Last Name:HUYNH
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:661-829-2700
Mailing Address - Street 1:2860 MICHELLE DRIVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92606-1009
Mailing Address - Country:US
Mailing Address - Phone:714-845-8890
Mailing Address - Fax:714-845-8803
Practice Address - Street 1:9510 HAGEMAN RD
Practice Address - Street 2:STE. B
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93312-3953
Practice Address - Country:US
Practice Address - Phone:661-829-2700
Practice Address - Fax:661-829-2770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2013-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401301223G0001X
CA438601223P0300X
CA374401223S0112X
CA497671223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty