Individual
PETER D WAITE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS, MD
Contact information
Practice address
619 19TH ST S, BIRMINGHAM, AL 35249-1900
(205) 934-4011
(205) 297-9411
Mailing address
PO BOX 55310, BIRMINGHAM, AL 35255-5310
(205) 731-9701
(205) 297-9411
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
03805
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
009944575
—
AL
01
—
051519858
BLUE CROSS
AL
Enumeration date
03/08/2006
Last updated
06/15/2011
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