Healthcare Provider Details

I. General information

NPI: 1902597321
Provider Name (Legal Business Name): MICHAEL PATRICK WALDRON DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11225 US HIGHWAY 301 N
PARRISH FL
34219-8675
US

IV. Provider business mailing address

8007 US HIGHWAY 19 NORTH
PINELLAS PARK FL
33758
US

V. Phone/Fax

Practice location:
  • Phone: 941-418-0001
  • Fax:
Mailing address:
  • Phone: 845-323-0594
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28240
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: