Provider Demographics
NPI:1831354166
Name:IWASAKI, DONALD MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MARK
Last Name:IWASAKI
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 1:11957 SANTA MONICA BLVD.
Mailing Address - Street 2:SUITE #200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025
Mailing Address - Country:US
Mailing Address - Phone:310-479-1387
Mailing Address - Fax:
Practice Address - Street 1:11957 SANTA MONICA BLVD.
Practice Address - Street 2:SUITE #200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-479-1387
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-25
Last Update Date:2008-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD22985122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist