Provider Demographics
NPI:1447241575
Name:DENNIS P WALDMAN DDS INC
Entity Type:Organization
Organization Name:DENNIS P WALDMAN DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:P
Authorized Official - Last Name:WALDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:310-823-9203
Mailing Address - Street 1:7740 W MANCHESTER AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PLAYA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90293-6400
Mailing Address - Country:US
Mailing Address - Phone:310-823-9203
Mailing Address - Fax:310-823-4007
Practice Address - Street 1:7740 W MANCHESTER AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:PLAYA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90293-6400
Practice Address - Country:US
Practice Address - Phone:310-823-9203
Practice Address - Fax:310-823-4007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24619122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty