Healthcare Provider Details

I. General information

NPI: 1487720223
Provider Name (Legal Business Name): DAVID S WALD DMD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 SOUTH STREET
NORTHBOROUGH MA
01532
US

IV. Provider business mailing address

29 SOUTH STREET
NORTHBOROUGH MA
01532
US

V. Phone/Fax

Practice location:
  • Phone: 508-393-7495
  • Fax: 508-393-4294
Mailing address:
  • Phone: 508-393-7495
  • Fax: 508-393-4294

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number18537
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number11080
License Number StateMA

VIII. Authorized Official

Name: DAVID S WALD
Title or Position: DENTIST OWNER
Credential: DMD
Phone: 508-393-7495