Provider Demographics
NPI:1003591363
Name:WATERMAN, SYDNEY (DDS)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 1ST AVE NE UNIT 553
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55413-3156
Mailing Address - Country:US
Mailing Address - Phone:605-216-3641
Mailing Address - Fax:
Practice Address - Street 1:5350 S ROBERT TRL
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55077-1404
Practice Address - Country:US
Practice Address - Phone:651-450-9579
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
MND149231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice