Provider Demographics
NPI:1154458073
Name:WALDEN, BRENDA CARTER (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:CARTER
Last Name:WALDEN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725A KENTON ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42101-4917
Mailing Address - Country:US
Mailing Address - Phone:270-782-0414
Mailing Address - Fax:270-782-0414
Practice Address - Street 1:725A KENTON ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-4917
Practice Address - Country:US
Practice Address - Phone:270-782-0414
Practice Address - Fax:270-782-0414
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY57551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice