Provider Demographics
NPI:1982607545
Name:WAXMAN, GERALD MARTIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:MARTIN
Last Name:WAXMAN
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:GERALD M. WAXMAN, DDS, INC. 2101 RICHMOND ROAD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122
Mailing Address - Country:US
Mailing Address - Phone:216-831-8461
Mailing Address - Fax:216-831-8462
Practice Address - Street 1:2101 RICHMOND RD
Practice Address - Street 2:
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-1391
Practice Address - Country:US
Practice Address - Phone:216-831-8461
Practice Address - Fax:216-831-8462
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2008-02-28
Deactivation Date:2006-03-17
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
OH10708122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist