Provider Demographics
NPI:1437282480
Name:WALDEN & BRIDGES PARTNERSHIP DENTISTRY
Entity Type:Organization
Organization Name:WALDEN & BRIDGES PARTNERSHIP DENTISTRY
Other - Org Name:PADUCAH DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:270-444-6414
Mailing Address - Street 1:5154 VILLAGE SQUARE DR
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-9060
Mailing Address - Country:US
Mailing Address - Phone:270-444-6414
Mailing Address - Fax:270-444-6488
Practice Address - Street 1:5154 VILLAGE SQUARE DR
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-9060
Practice Address - Country:US
Practice Address - Phone:270-444-6414
Practice Address - Fax:270-444-6488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY79561223G0001X
KY55671223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty