Provider Demographics
NPI:1477652618
Name:DO-YABUT AND WATANABE DENTAL CORPORATION
Entity Type:Organization
Organization Name:DO-YABUT AND WATANABE DENTAL CORPORATION
Other - Org Name:BEAR CREEK DENTAL GROUP AND ORTHODONTICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:WATANABE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-678-0790
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:714-508-3600
Mailing Address - Fax:714-368-2092
Practice Address - Street 1:36068 HIDDEN SPRINGS RD
Practice Address - Street 2:SUITE H
Practice Address - City:WILDOMAR
Practice Address - State:CA
Practice Address - Zip Code:92595-7679
Practice Address - Country:US
Practice Address - Phone:951-678-0790
Practice Address - Fax:951-678-0796
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401301223G0001X
CA497841223G0001X
CA381301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty