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General NPI Number Information
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NPI Number | 1144341595
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Entity Type | Individual
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Provider Name | BRUCE DONALD WATERMAN D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/03/2007
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Last Update Date | 04/13/2021
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Provider Practice Location Address
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Address Line | 5706 BENJAMIN CENTER DR STE 103
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City | TAMPA
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State | FL
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Zip | 33634-5262
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Country | US
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Telephone | 813-288-1999
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Fax | 813-289-4500
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Provider Business Mailing Address
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Address Line | 127 KINGSWAY RD SUITE A
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City | BRANDON
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State | FL
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Zip | 33510-4605
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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 |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN9391
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License Number State | FL
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