Provider Demographics
NPI:1285746305
Name:WATANABE, STEVEN KIYOSHI (DDS)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:KIYOSHI
Last Name:WATANABE
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 1:25880 TOURNAMENT ROAD
Mailing Address - Street 2:SUITE 213
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91355
Mailing Address - Country:US
Mailing Address - Phone:661-254-5053
Mailing Address - Fax:
Practice Address - Street 1:25880 TOURNAMENT RD
Practice Address - Street 2:SUITE 213
Practice Address - City:SANTA CLARITA
Practice Address - State:CA
Practice Address - Zip Code:91355-2349
Practice Address - Country:US
Practice Address - Phone:661-254-5053
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA278521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice