Bruce Donald Waterman, D.M.D.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN9391 Issued in FL

Practice address

5706 Benjamin Center Dr Ste 103
Tampa, FL 33634-5262

Phone

(813) 288-1999

Fax

(813) 289-4500

NPI assigned

Apr 3, 2007

Sex

Male

Sole proprietor

Yes

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

Enrolled in FL

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

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

{
    "created_epoch": "1175558400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1618272000000",
    "number": "1144341595",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "127 KINGSWAY RD",
            "address_2": "SUITE A",
            "city": "BRANDON",
            "state": "FL",
            "postal_code": "335104605",
            "telephone_number": "813-689-8462",
            "fax_number": "813-684-5665"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5706 BENJAMIN CENTER DR STE 103",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336345262",
            "telephone_number": "813-288-1999",
            "fax_number": "813-289-4500"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "127 Kingsway Rd",
            "address_2": "Suite A",
            "address_purpose": "LOCATION",
            "city": "Brandon",
            "state": "FL",
            "postal_code": "335104605",
            "country_code": "US",
            "telephone_number": "813-689-8462",
            "fax_number": "813-684-5665",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "BRUCE",
        "middle_name": "DONALD",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-04-03",
        "last_updated": "2021-04-13",
        "certification_date": "2021-04-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN9391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Pranav Wasti, M.D.
• Michael A. Wasylik, M.D.
• Roman T Wasylyk
• Mana Watanabe
• Maya Waterbury, PT, DPT
• Waters Community Pharmacy
• Waters Medical Clinic, LLC
• Waters Medical Rehab, Inc
• Alicia Michelle Waters, M.D.
• Chanel Waters

• General Practice Dentistry in Tampa, FL
• Providers in Tampa, FL by specialty
• General Practice Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.