Provider Demographics
NPI:1225212376
Name:MEDEN, WALTER (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:MEDEN
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 1:1680 REUNION AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-4617
Mailing Address - Country:US
Mailing Address - Phone:801-446-7800
Mailing Address - Fax:801-446-7170
Practice Address - Street 1:1680 REUNION AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84095-4617
Practice Address - Country:US
Practice Address - Phone:801-446-7800
Practice Address - Fax:801-446-7170
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-26
Last Update Date:2007-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9835539299221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice