Provider Demographics
NPI:1902942550
Name:WALDRON, DENISE LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:LYNN
Last Name:WALDRON
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 1:5 PROFESSIONAL CIR
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLTS NECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07722-2428
Mailing Address - Country:US
Mailing Address - Phone:732-431-1919
Mailing Address - Fax:732-358-0100
Practice Address - Street 1:5 PROFESSIONAL CIR
Practice Address - Street 2:SUITE 109
Practice Address - City:COLTS NECK
Practice Address - State:NJ
Practice Address - Zip Code:07722-2428
Practice Address - Country:US
Practice Address - Phone:732-431-1919
Practice Address - Fax:732-358-0100
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI016351001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice