Healthcare Provider Details

I. General information

NPI: 1184860413
Provider Name (Legal Business Name): VADIM VALDMAN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/16/2008
Last Update Date: 12/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12801 W SUNRISE BLVD STE F222
SUNRISE FL
33323-4020
US

IV. Provider business mailing address

12801 W SUNRISE BLVD STE F222
SUNRISE FL
33323-4020
US

V. Phone/Fax

Practice location:
  • Phone: 954-846-7171
  • Fax: 954-846-7170
Mailing address:
  • Phone: 954-846-7171
  • Fax: 954-846-7170

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN17761
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: