Healthcare Provider Details

I. General information

NPI: 1831533348
Provider Name (Legal Business Name): JOSHUA RAND WALDRON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/26/2013
Last Update Date: 05/15/2024
Certification Date: 05/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 UNIT 33100
APO AE
09180
US

IV. Provider business mailing address

CMR 402 UNIT 33100
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 314-590-1515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8330101-9922
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number8330101-9926
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: