Healthcare Provider Details

I. General information

NPI: 1447241575
Provider Name (Legal Business Name): DENNIS P WALDMAN DDS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7740 W MANCHESTER AVE SUITE 201
PLAYA DEL REY CA
90293-6400
US

IV. Provider business mailing address

7740 W MANCHESTER AVE SUITE 201
PLAYA DEL REY CA
90293-6400
US

V. Phone/Fax

Practice location:
  • Phone: 310-823-9203
  • Fax: 310-823-4007
Mailing address:
  • Phone: 310-823-9203
  • Fax: 310-823-4007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number24619
License Number StateCA

VIII. Authorized Official

Name: DENNIS P WALDMAN
Title or Position: OWNER
Credential: DDS
Phone: 310-823-9203