NPIMap

Organization Active NPI

Diana DO-Yabut and Bryan Watanabe Dental Corporation

  • General Practice Dentistry
  • Wildomar, CA
National Provider Identifier
1457445231
Registry record updated Jul 2, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
40130 Issued in CA
Legal business name
DIANA DO-YABUT AND BRYAN WATANABE DENTAL CORPORATION
Practice address
23905 Clinton Keith Rd
Ste. 108
Wildomar, CA 92595-7897
Phone
(951) 304-9700
Fax
(951) 304-9711
NPI assigned
Oct 3, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 2, 2012

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

Authorized official

Name
Dr. Bryan K Watanabe, DDS
Title
Owner DDS
Phone
(951) 304-9700

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 40130 CA Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X 49784 CA
PeriodonticsGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0300X 37772 CA
Oral and Maxillofacial Surgery (Dentist)Group: 193200000X MULTI-SPECIALTY GROUP 1223S0112X 50080 CA

Addresses

Primary practice location

23905 Clinton Keith Rd
Ste. 108
Wildomar, CA 92595-7897

Mailing address

2860 Michelle Drive
2ND Floor
Irvine, CA 92606-1009
Phone (714) 368-2077

Other names 1

  • Clinton Keith Dental Group Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

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

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
05D2345809Clinton Keith Dental Group23905 Clinton Keith Rd, Ste 108, Wildomar, CA 92595Certificate of waiverJun 16, 2028

National Provider Directory

National Provider Directory

Locations

23905 Clinton Keith Rd
Ste 108
Wildomar, CA 92595
Phone (951) 304-9700

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1159833600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1341187200000",
    "number": "1457445231",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2860 MICHELLE DRIVE",
            "address_2": "2ND FLOOR",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926061009",
            "telephone_number": "714-368-2077",
            "fax_number": "714-368-2092"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "23905 CLINTON KEITH RD",
            "address_2": "STE. 108",
            "city": "WILDOMAR",
            "state": "CA",
            "postal_code": "925957897",
            "telephone_number": "951-304-9700",
            "fax_number": "951-304-9711"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DIANA DO-YABUT AND BRYAN WATANABE DENTAL CORPORATION",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-10-03",
        "last_updated": "2012-07-02",
        "status": "A",
        "authorized_official_last_name": "WATANABE",
        "authorized_official_first_name": "BRYAN",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER DDS",
        "authorized_official_telephone_number": "951-304-9700",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "40130",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "49784",
            "primary": false
        },
        {
            "code": "1223P0300X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Periodontics",
            "state": "CA",
            "license": "37772",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "CA",
            "license": "50080",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Clinton Keith Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Wildomar, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 2, 2012; 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.