Provider Demographics
NPI:1467593657
Name:WALDEN, TERRY R (DDS)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:R
Last Name:WALDEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8680 W MAIN ST
Mailing Address - Street 2:4W
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034-3096
Mailing Address - Country:US
Mailing Address - Phone:972-335-2175
Mailing Address - Fax:972-712-0398
Practice Address - Street 1:8680 W MAIN ST
Practice Address - Street 2:4W
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-3096
Practice Address - Country:US
Practice Address - Phone:972-335-2175
Practice Address - Fax:972-712-0398
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2016-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115441223G0001X
TX11,5441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice