Organization
FAIRVIEW HEIGHTS DENTISTRY, PLLC
Active
Other names
Fairview Heights Dentistry
Organization subpart
No
Provider details
NPI number
Authorized official
BRYAN K WATANABE (OWNER)
(618) 310-0263
Entity
Organization
Contact information
Practice address
6407 N ILLINOIS ST, FAIRVIEW HEIGHTS, IL 62208-2720
(618) 310-0263
(618) 212-9054
Mailing address
PO BOX 920050, DALLAS, TX 75392-0050
(714) 845-8500
(303) 952-0892
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
06/26/2019
Last updated
03/08/2022
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