Active NPI
Chad Waltz, DDS
- Endodontics
- Brandon, FL
National Provider Identifier
1659787398
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Endodontics
- License
- DN21983
- Practice address
- 625 Eichenfeld Dr
Brandon, FL 33511-5908 - Phone
- (813) 654-3636
- Fax
- (813) 651-4984
- NPI assigned
- Jul 2, 2014
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Endodontics | 1223E0200X | DN21983 | FL | Primary |
Addresses
Primary practice location
625 Eichenfeld Dr
Brandon, FL 33511-5908
Mailing address
3313 Las Campos PL
Tampa, FL 33611-2968
Phone (319) 331-6605
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
| License | State | Type | Specialty |
|---|---|---|---|
| DN21983 | FL | MD | Endodontist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Brandon Endodontics, PA | Endodontics | Past | Accepting new patients |
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.
-
dba Advanced Endodontics of Tampa Bay
- Dentist
- Brandon, FL
- NPI 1841368974
Endodontics
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1404259200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1469664000000",
"number": "1659787398",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3313 LAS CAMPOS PL",
"city": "TAMPA",
"state": "FL",
"postal_code": "336112968",
"telephone_number": "319-331-6605"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "625 EICHENFELD DR",
"city": "BRANDON",
"state": "FL",
"postal_code": "335115908",
"telephone_number": "813-654-3636",
"fax_number": "813-651-4984"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WALTZ",
"first_name": "CHAD",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-07-02",
"last_updated": "2016-07-28",
"status": "A"
},
"taxonomies": [
{
"code": "1223E0200X",
"taxonomy_group": "",
"desc": "Dentist, Endodontics",
"state": "FL",
"license": "DN21983",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Brandon, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 28, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.