MEDICARE: DENNIS P WALDMAN DDS INC

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	24619	CA

General Provider Information

NPI Number	:	1447241575
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENNIS P WALDMAN DDS INC

Provider Business Mailing Address
First Line	:	7740 W MANCHESTER AVE
Second Line	:	SUITE 201
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-6400
Country	:	US
Telephone Number	:	310-823-9203
Fax Number	:	310-823-4007

Provider Business Practice Location Address
First Line	:	7740 W MANCHESTER AVE
Second Line	:	SUITE 201
City	:	PLAYA DEL REY
State	:	CA
Zip	:	90293-6400
Country	:	US
Telephone Number	:	310-823-9203
Fax Number	:	310-823-4007

Authorized Official
Title or Position	:	OWNER
Name	:	DENNIS P WALDMAN
Credential	:	DDS
Telephone Number	:	310-823-9203

Provider Enumeration Date	:	10/28/2005
Last Update Date	:	08/22/2020

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