Alvin Shinichi Watanabe, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DE5767 Issued in WA

Practice address

14201 NE 20TH Ave
Suite 1101
Vancouver, WA 98686-6410

Phone

(360) 882-0222

Fax

(360) 546-3355

NPI assigned

Jun 9, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in OR

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

State licenses

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

{
    "created_epoch": "1149811200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1687305600000",
    "number": "1285675652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14201 NE 20TH AVE STE A101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866411",
            "telephone_number": "360-571-8181",
            "fax_number": "360-573-4029"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14201 NE 20TH AVE",
            "address_2": "SUITE 1101",
            "city": "VANCOUVER",
            "state": "WA",
            "postal_code": "986866410",
            "telephone_number": "360-882-0222",
            "fax_number": "360-546-3355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "ALVIN",
        "middle_name": "SHINICHI",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-06-09",
        "last_updated": "2023-06-21",
        "certification_date": "2023-06-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "OR",
            "license": "D6001",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WA",
            "license": "DE5767",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Washington State University
• Washington Women'S Sexual Health
• Ashlea Washington
• Juanita Washington
• Larry Lee Wasilenkoff, D.C.
• Waterford Outpatient Rehabilitation Clinic
• Karen T Waters, LMHC
• Charles Watkins
• Gina Marie Watkins, LCSW, LICSW
• Jeannette Rebecca Watkins

• General Practice Dentistry in Vancouver, WA
• Providers in Vancouver, WA by specialty
• General Practice Dentistry in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 21, 2023; 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.