Provider Demographics
NPI:1063556314
Name:WALDRON, DAVID ALEC (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALEC
Last Name:WALDRON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 GRAHAM RD
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-1049
Mailing Address - Country:US
Mailing Address - Phone:330-929-7344
Mailing Address - Fax:330-929-4465
Practice Address - Street 1:802 GRAHAM RD
Practice Address - Street 2:
Practice Address - City:CUYAHOGA FALLS
Practice Address - State:OH
Practice Address - Zip Code:44221-1049
Practice Address - Country:US
Practice Address - Phone:330-929-7344
Practice Address - Fax:330-929-4465
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH14993122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist