=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558389551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GENE WALDMAN DDS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/17/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1708 FRANKLIN ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-3408
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-893-3611
-----------------------------------------------------
Fax | 510-832-1542
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3220 NEWPORT CT
-----------------------------------------------------
City | WALNUT CREEK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94598-3617
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 925-943-1837
-----------------------------------------------------
Fax | 510-832-1542
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 27081
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------