Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0700X | Prosthodontist | DS-026624-L | PA |
NPI | 1063506277 |
---|---|
Provider Name | Dr. John Louis Waldman |
First Address | Pgh, PA 15222 |
Second Address | Pgh, PA 15222 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/10/2006 |
Last Update Date | 16/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
25-1636953 | FEDERAL I.D. NUMBER (01) | PA |
DS-026624-L | DENTAL LICENSE NUMBER (01) | PA |