1851698484 NPI number — RYAN WATKINS DDS INC.

Table of content: (NPI 1851698484)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851698484 NPI number — RYAN WATKINS DDS INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RYAN WATKINS DDS INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
DREAMTIME DENTISTRY DENTAL GROUP
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1851698484
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
950 VISTA VILLAGE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VISTA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92084-6064
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-720-0451
Provider Business Mailing Address Fax Number:
866-779-9096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
950 VISTA VILLAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VISTA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92084-6064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-274-0993
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/16/2011

Additional Information

Authorized Official

Authorized Official Last Name:
WATKINS
Authorized Official First Name:
RYAN
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
805-405-4975

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  52130 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PQ8456 . This is a "SAN DIEGO REGIONAL CENTER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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