Provider Demographics
NPI:1184860413
Name:VALDMAN, VADIM (DDS)
Entity Type:Individual
Prefix:
First Name:VADIM
Middle Name:
Last Name:VALDMAN
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 1:12801 W SUNRISE BLVD STE F222
Mailing Address - Street 2:
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-4020
Mailing Address - Country:US
Mailing Address - Phone:954-846-7171
Mailing Address - Fax:954-846-7170
Practice Address - Street 1:12801 W SUNRISE BLVD STE F222
Practice Address - Street 2:
Practice Address - City:SUNRISE
Practice Address - State:FL
Practice Address - Zip Code:33323-4020
Practice Address - Country:US
Practice Address - Phone:954-846-7171
Practice Address - Fax:954-846-7170
Is Sole Proprietor?:No
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN177611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice