Provider Demographics
NPI:1629170303
Name:WALDEN, PAMELA C (DMD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:C
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 1:10658 BRIDLEPATH LN
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9519
Mailing Address - Country:US
Mailing Address - Phone:859-384-8065
Mailing Address - Fax:
Practice Address - Street 1:1982 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:UNION
Practice Address - State:KY
Practice Address - Zip Code:41091-8636
Practice Address - Country:US
Practice Address - Phone:859-384-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist