Provider Demographics
NPI:1013199827
Name:WALDEN, ALFRED FREEMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALFRED
Middle Name:FREEMAN
Last Name:WALDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PRISON RD
Mailing Address - Street 2:
Mailing Address - City:REPRESA
Mailing Address - State:CA
Mailing Address - Zip Code:95671-3001
Mailing Address - Country:US
Mailing Address - Phone:916-985-2561
Mailing Address - Fax:916-608-3105
Practice Address - Street 1:1614 X ST
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95818-2300
Practice Address - Country:US
Practice Address - Phone:916-446-1588
Practice Address - Fax:916-446-1587
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAD22583122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist