Provider Demographics
NPI:1902220320
Name:BRUCE WATERMAN DMD, SLEEP EZ,PL
Entity Type:Organization
Organization Name:BRUCE WATERMAN DMD, SLEEP EZ,PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:DONALD
Authorized Official - Last Name:WATERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:813-689-8462
Mailing Address - Street 1:127 KINGSWAY RD
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4601
Mailing Address - Country:US
Mailing Address - Phone:813-689-8462
Mailing Address - Fax:813-684-5665
Practice Address - Street 1:127 KINGSWAY RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33510-4601
Practice Address - Country:US
Practice Address - Phone:813-689-8462
Practice Address - Fax:813-684-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-05
Last Update Date:2014-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN9391261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental