Provider Demographics
NPI:1104049634
Name:KAWATA, STEVEN K (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:K
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 1:1401 AVOCADO AVE
Mailing Address - Street 2:SUITE 607
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7720
Mailing Address - Country:US
Mailing Address - Phone:949-760-3811
Mailing Address - Fax:949-759-9168
Practice Address - Street 1:1401 AVOCADO AVE
Practice Address - Street 2:SUITE 607
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7720
Practice Address - Country:US
Practice Address - Phone:949-760-3811
Practice Address - Fax:949-759-9168
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA241261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice