MEDICARE: DR. BRUCE DONALD WATERMAN D.M.D.

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	DN9391	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1144341595
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BRUCE DONALD WATERMAN D.M.D.

Provider Business Mailing Address
First Line	:	127 KINGSWAY RD
Second Line	:	SUITE A
City	:	BRANDON
State	:	FL
Zip	:	33510-4605
Country	:	US
Telephone Number	:	813-689-8462
Fax Number	:	813-684-5665

Provider Business Practice Location Address
First Line	:	5706 BENJAMIN CENTER DR STE 103
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33634-5262
Country	:	US
Telephone Number	:	813-288-1999
Fax Number	:	813-289-4500

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	04/13/2021

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