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General NPI Number Information
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NPI Number | 1013325265
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Entity Type | Organization
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Legal Business Name | BRUCE D. WATERMAN, DMD,PA
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Dates
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Enumeration Date | 07/31/2014
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Last Update Date | 07/31/2014
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Provider Practice Location Address
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Address Line | 127 KINGSWAY RD
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City | BRANDON
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State | FL
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Zip | 33510-4601
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Country | US
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Telephone | 813-689-8462
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Fax | 813-684-5665
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Provider Business Mailing Address
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Address Line | 127 KINGSWAY RD
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City | BRANDON
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State | FL
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Zip | 33510-4601
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Country | US
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Telephone | 813-689-8462
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Fax | 813-684-5665
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. BRUCE DONALD WATERMAN
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Credential | DMD
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Telephone | 813-689-8462
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | DN9391
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License Number State | FL
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