Sydney Waterman, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D14923 Issued in MN

Practice address

5350 S Robert TRL
Inver Grove Heights, MN 55077-1404

Phone

(651) 450-9579

NPI assigned

Jun 15, 2023

Last updated

Jun 15, 2023By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• PDG, P.a.

  dba Park Dental

  • General Practice Dentistry
  • Inver Grove Heights, MN
  • NPI 1710045117
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1686787200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686787200000",
    "number": "1003591363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "401 1ST AVE NE UNIT 553",
            "city": "MINNEAPOLIS",
            "state": "MN",
            "postal_code": "554133156",
            "telephone_number": "605-216-3641"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5350 S ROBERT TRL",
            "city": "INVER GROVE HEIGHTS",
            "state": "MN",
            "postal_code": "550771404",
            "telephone_number": "651-450-9579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "SYDNEY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D14923",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Alicia Wales, PT, DPT
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• Bradley Wallace
• Walmart Inc. (Walmart Pharmacy 10-5089)
• We Care Assisted Living L.L.C.
• Lara Madalyn Weaver, LSW, MSW
• Philip J Weber, MD
• Michelle Lynn Weinzirl, LPN
• Well Med, PA

• General Practice Dentistry in Inver Grove Heights, MN
• Providers in Inver Grove Heights, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.