Provider Demographics
NPI:1952485492
Name:WALDEN III, HILMAN ALEXANDER (DMD)
Entity Type:Individual
Prefix:
First Name:HILMAN
Middle Name:ALEXANDER
Last Name:WALDEN III
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:709 E SHOTWELL ST
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:39819-4063
Mailing Address - Country:US
Mailing Address - Phone:229-246-5081
Mailing Address - Fax:229-246-5011
Practice Address - Street 1:709 E SHOTWELL ST
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:39819-4063
Practice Address - Country:US
Practice Address - Phone:229-246-5081
Practice Address - Fax:229-246-5011
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0126151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA335406129BMedicaid