Provider Demographics
NPI:1932400660
Name:WATERMAN, CRISTINA L (DMD)
Entity Type:Individual
Prefix:DR
First Name:CRISTINA
Middle Name:L
Last Name:WATERMAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7787 SW HANSEN LN
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97224-0006
Mailing Address - Country:US
Mailing Address - Phone:503-502-4012
Mailing Address - Fax:
Practice Address - Street 1:8568 SW APPLE WAY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97225-1772
Practice Address - Country:US
Practice Address - Phone:503-292-6773
Practice Address - Fax:503-246-4206
Is Sole Proprietor?:No
Enumeration Date:2010-11-11
Last Update Date:2021-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD94831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice