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29273 Central Ave Ste. A Lake Elsinore CA 92532-2254 | |
| (951) 245-8664 | |
| (951) 245-9392 |
| Full Name | |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 29273 Central Ave, Lake Elsinore, California |
| Authorized Official Name and Position | Bryan Watanabe (OWNER DDS) |
| Authorized Official Contact | 9512458664 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
2860 Michelle 2nd Floor Irvine CA 92606-1009 Ph: (714) 508-3600 | 29273 Central Ave Ste. A Lake Elsinore CA 92532-2254 Ph: (951) 245-8664 |
| NPI Number | 1396830790 |
|---|---|
| Provider Enumeration Date | 10/03/2006 |
| Last Update Date | 06/04/2009 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1396830790 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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