Provider Demographics
NPI:1154006302
Name:WATERMAN, KAMRAN (DMD)
Entity type:Individual
Prefix:
First Name:KAMRAN
Middle Name:
Last Name:WATERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5715 ATRIUM DR UNIT 130
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80108-1927
Mailing Address - Country:US
Mailing Address - Phone:720-805-2425
Mailing Address - Fax:
Practice Address - Street 1:5715 ATRIUM DR UNIT 130
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80108-1927
Practice Address - Country:US
Practice Address - Phone:720-805-2425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00205652122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist