Provider Demographics
NPI:1528226503
Name:KAWATA, BEN R (DDS)
Entity Type:Individual
Prefix:DR
First Name:BEN
Middle Name:R
Last Name:KAWATA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12211 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1134
Mailing Address - Country:US
Mailing Address - Phone:310-826-6123
Mailing Address - Fax:310-207-8686
Practice Address - Street 1:12211 W PICO BLVD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1134
Practice Address - Country:US
Practice Address - Phone:310-826-6123
Practice Address - Fax:310-207-8686
Is Sole Proprietor?:No
Enumeration Date:2008-05-27
Last Update Date:2008-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36948122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist