Provider Demographics
NPI:1235319898
Name:SCOT K WATASE DMD INC.
Entity Type:Organization
Organization Name:SCOT K WATASE DMD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOT
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATASE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:323-724-1330
Mailing Address - Street 1:505 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3621
Mailing Address - Country:US
Mailing Address - Phone:323-724-1330
Mailing Address - Fax:323-724-4356
Practice Address - Street 1:505 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3621
Practice Address - Country:US
Practice Address - Phone:323-724-1330
Practice Address - Fax:323-724-4356
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-11
Last Update Date:2013-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA428961223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty