Provider Demographics
NPI:1609085133
Name:IWATA, CHRISTOPHER A (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:A
Last Name:IWATA
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 1:665 W 21ST ST
Mailing Address - Street 2:APT 2
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-5550
Mailing Address - Country:US
Mailing Address - Phone:310-832-1440
Mailing Address - Fax:
Practice Address - Street 1:665 W 21ST ST
Practice Address - Street 2:APT 2
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-5550
Practice Address - Country:US
Practice Address - Phone:310-832-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA255451223G0001X
AK4691223G0001X
WADE000069551223G0001X
HIDT13541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice