Provider Demographics
NPI:1275607269
Name:WALDEN, DAVID C (DDS)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:C
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:PO BOX 338
Mailing Address - Street 2:
Mailing Address - City:ELLETTSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47429-0338
Mailing Address - Country:US
Mailing Address - Phone:812-876-4624
Mailing Address - Fax:812-876-8319
Practice Address - Street 1:319 W TEMPERANCE ST
Practice Address - Street 2:
Practice Address - City:ELLETTSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47429-1534
Practice Address - Country:US
Practice Address - Phone:812-876-4624
Practice Address - Fax:812-876-8319
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1200D82431223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice