Douglas T. Watanabe, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

11564 Issued in MO

Practice address

2821 N Ballas Rd
Suite 140
Saint Louis, MO 63131-2321

Phone

(314) 432-5544

Fax

(314) 432-7815

NPI assigned

Aug 16, 2006

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

Enrolled in MO

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

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Ballasdental

  • Special Hospital
  • Saint Louis, MO
  • NPI 1881059673
  NPD (past)

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

{
    "created_epoch": "1155686400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1467565416",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2821 N BALLAS RD",
            "address_2": "SUITE 140",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312321",
            "telephone_number": "314-432-5544",
            "fax_number": "314-432-7815"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2821 N BALLAS RD",
            "address_2": "SUITE 140",
            "city": "SAINT LOUIS",
            "state": "MO",
            "postal_code": "631312321",
            "telephone_number": "314-432-5544",
            "fax_number": "314-432-7815"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATANABE",
        "first_name": "DOUGLAS",
        "middle_name": "T.",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-16",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MO",
            "license": "11564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Gary M Wasserman, MD
• Max Wasserman
• Scott P Wasserstrom, MD
• Andrew James Wasson, RN, BSN, CDN
• Seth Wasson, DMD
• Tsugie Watanabe, CRNA
• Julie Lynne Waterbury, A.P.R.N.-F.N.P
• Kathryn Waterbury, MSW, LCSW
• Kristen Wymore Waterbury, MD
• Amber Dawn Waters

• General Practice Dentistry in Saint Louis, MO
• Providers in Saint Louis, MO by specialty
• General Practice Dentistry in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.