Provider Demographics
NPI:1144341595
Name:WATERMAN, BRUCE DONALD (DMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:DONALD
Last Name:WATERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 KINGSWAY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33510-4605
Mailing Address - Country:US
Mailing Address - Phone:813-689-8462
Mailing Address - Fax:813-684-5665
Practice Address - Street 1:5706 BENJAMIN CENTER DR STE 103
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33634-5262
Practice Address - Country:US
Practice Address - Phone:813-288-1999
Practice Address - Fax:813-289-4500
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN93911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice