Marisa Kawata Watanabe, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

58885 Issued in CA

Practice address

1405 Montgomery St
Tustin, CA 92782-1793

Phone

(714) 415-9409

NPI assigned

Sep 15, 2011

Last updated

Sep 15, 2011By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1316044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1316044800000",
    "number": "1124300132",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1405 MONTGOMERY ST",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927821793",
            "telephone_number": "714-415-9409"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1405 MONTGOMERY ST",
            "city": "TUSTIN",
            "state": "CA",
            "postal_code": "927821793",
            "telephone_number": "714-415-9409"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "MARISA",
        "middle_name": "KAWATA",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-09-15",
        "last_updated": "2011-09-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "58885",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Hsing-an Daisy Wang, BCBA
• Lisa Wang
• Susan Wang, FNP-BC
• Robert Frederick Warburton, ARNP
• John Bruce Warner, D.D.S.
• Sarah Waterkamp, D.C.
• Natsuko Watkins
• Leah Marie Watson, LVN
• Waymakers (CYS Waymakers Children's Specialized Services)
• Barbara Jeanne Wayne, PH.D.

• General Practice Dentistry in Tustin, CA
• Providers in Tustin, 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 Sep 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.