Provider Demographics
NPI:1720129174
Name:WALDMAN, DAVID H
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:WALDMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8536 LONG BEACH BLVD
Mailing Address - Street 2:B
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280
Mailing Address - Country:US
Mailing Address - Phone:323-581-0754
Mailing Address - Fax:323-581-2106
Practice Address - Street 1:8536 LONG BEACH BLVD
Practice Address - Street 2:B
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280
Practice Address - Country:US
Practice Address - Phone:323-581-0754
Practice Address - Fax:323-581-2106
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAW12981511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice