MEDICARE: NBW, D.D.S., INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	DN 0010851	FL

General Provider Information

NPI Number	:	1043328024
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NBW, D.D.S., INC.

Provider Business Mailing Address
First Line	:	2808 N. REMINGTON GREEN CIRCLE
Second Line	:	SUITE 100
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308
Country	:	US
Telephone Number	:	850-383-1052
Fax Number	:	850-383-1366

Provider Business Practice Location Address
First Line	:	2808 N. REMINGTON GREEN CIRCLE
Second Line	:	SUITE 100
City	:	TALLAHASSEE
State	:	FL
Zip	:	32308
Country	:	US
Telephone Number	:	850-383-1052
Fax Number	:	850-383-1366

Authorized Official
Title or Position	:	DENTIST/PRESIDENT
Name	:	NEAL B WALDMAN
Credential	:	DDS
Telephone Number	:	850-383-1052

Provider Enumeration Date	:	08/29/2006
Last Update Date	:	04/18/2013

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