MEDICARE: DR. DAVID ALEC WALDRON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	14993	OH

General Provider Information

NPI Number	:	1063556314
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID ALEC WALDRON DDS

Provider Business Mailing Address
First Line	:	802 GRAHAM RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-1049
Country	:	US
Telephone Number	:	330-929-7344
Fax Number	:	330-929-4465

Provider Business Practice Location Address
First Line	:	802 GRAHAM RD
Second Line	:
City	:	CUYAHOGA FALLS
State	:	OH
Zip	:	44221-1049
Country	:	US
Telephone Number	:	330-929-7344
Fax Number	:	330-929-4465

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/19/2007
Last Update Date	:	07/08/2007

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