Mark Watanabe

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

102904 Issued in CA

Practice address

201 Walnut Ave
Vallejo, CA 94592-1107

Phone

(707) 562-8229

NPI assigned

Jul 25, 2017

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1500940800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1592956800000",
    "number": "1043733660",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37475 BAY CREST RD",
            "city": "NEWARK",
            "state": "CA",
            "postal_code": "945603554"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 WALNUT AVE",
            "city": "VALLEJO",
            "state": "CA",
            "postal_code": "945921107",
            "telephone_number": "707-562-8229"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "MARK",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-07-25",
        "last_updated": "2020-06-24",
        "certification_date": "2020-06-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "102904",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Spencer H. Wang, MD
• Bailey Ward, MPH
• Jeffrey S Ward, ATC, CSCS
• Markeisha Washington
• Hisako Watanabe-Cenizal, CRNA
• Alice Waterman
• Jerald Deshawn Waters
• Susan Marie Watkins, PT
• Susan Ann Watson, L.M.F.T.
• Neil F. Watter, MD

• General Practice Dentistry in Vallejo, CA
• Providers in Vallejo, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 24, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.