Watanabe Shadow Mountain Dental Group, Professional Corporation

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

WATANABE SHADOW MOUNTAIN DENTAL GROUP, PROFESSIONAL CORPORATION

Doing business as

Shadow Mountain Dental Group

Practice address

6525 N Decatur Blvd
Suite 150
Las Vegas, NV 89131

Phone

(702) 577-1941

Fax

(702) 395-7813

NPI assigned

Nov 6, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Lynda C Watanabe, DDSNPI 1861505984

Title

Owner Doctor

Phone

(702) 577-1941

Specialties & licenses 1

Addresses

Other names 1

• SHADOW MOUNTAIN DENTAL GROUP Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Lynda C. Watanabe, DDS

  • General Practice Dentistry
  • Irvine, CA
  • NPI 1861505984
  Authorized official Same address or phone

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

{
    "created_epoch": "1194307200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1194393600000",
    "number": "1427238534",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-508-3600",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6525 N DECATUR BLVD",
            "address_2": "SUITE 150",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "89131",
            "telephone_number": "702-577-1941",
            "fax_number": "702-395-7813"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "WATANABE SHADOW MOUNTAIN DENTAL GROUP, PROFESSIONAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-06",
        "last_updated": "2007-11-07",
        "status": "A",
        "authorized_official_last_name": "WATANABE",
        "authorized_official_first_name": "LYNDA",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER DOCTOR",
        "authorized_official_telephone_number": "702-577-1941",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SHADOW MOUNTAIN DENTAL GROUP",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Gavin E Watabayashi, DPT
• Shizu Watabe
• Watanabe Diamond Dental Group, Professional Corporation (Diamond Dental Group)
• Watanabe Ranch Plaza Dental Group, PC (Ranch Plaza Dental Group)
• Watanabe Rocksprings Dental Group, PC (Rockspring Dental Corporation)
• Watanabe Spring Valley Dentist Office, PC (Spring Valley Dentist Office)
• Watanabe Town Center Dental Group, Professional Corporation (Montecito Town Center Dental Group)
• Liliko Watanabe
• Wilson T Watanabe, MD
• Jon Richard Watase

• General Practice Dentistry in Las Vegas, NV
• Providers in Las Vegas, NV by specialty
• General Practice Dentistry in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.