Provider Demographics
NPI:1225144496
Name:WASSERMAN, ALAN H (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:H
Last Name:WASSERMAN
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 1:2503 WALNUT ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80302-5748
Mailing Address - Country:US
Mailing Address - Phone:303-443-9565
Mailing Address - Fax:303-443-8897
Practice Address - Street 1:2503 WALNUT ST
Practice Address - Street 2:SUITE 200
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80302-5748
Practice Address - Country:US
Practice Address - Phone:303-443-9565
Practice Address - Fax:303-443-8897
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO009341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice