Individual provider Active NPI

Kamran Waterman, DMD

  • Dentist
  • Castle Rock, CO
National Provider Identifier
1154006302
Registry record updated Jun 15, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DEN.00205652 Issued in CO
Practice address
5715 Atrium Dr Unit 130
Castle Rock, CO 80108-1927
Phone
(720) 805-2425
NPI assigned
Jun 15, 2023
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 15, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DEN.00205652 CO Primary

Addresses

Primary practice location

5715 Atrium Dr Unit 130
Castle Rock, CO 80108-1927

Mailing address

5715 Atrium Dr Unit 130
Castle Rock, CO 80108-1927
Phone (720) 805-2425

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
DEN.00205652COMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Promenade Dentist Office and Orthodontics, LLP Dentist CurrentSince Jun 18, 2023 Accepting new patients

Locations

5715 Atrium Dr
Unit 130
Castle Rock, CO 80108
Phone (720) 805-2425

Organizations & group practices 1

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

NPI Registry JSON

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": "1154006302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5715 ATRIUM DR UNIT 130",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801081927",
            "telephone_number": "720-805-2425"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5715 ATRIUM DR UNIT 130",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801081927",
            "telephone_number": "720-805-2425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERMAN",
        "first_name": "KAMRAN",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-06-15",
        "last_updated": "2023-06-15",
        "certification_date": "2023-06-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CO",
            "license": "DEN.00205652",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Castle Rock, CO

Sources for this page

  • 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.