# GARY K. WALDEN DMD & BRENDA C. WALDEN DMD

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1962623496
- **Authorized official:** DR. GARY K WALDEN D.M.D. (OWNER)
- **Authorized official phone:** (270) 782-0414

## Contact information

- **Practice address:** 725A KENTON ST, BOWLING GREEN, KY 42101-4917
- **Practice address phone:** (270) 782-0414
- **Practice address fax:** (270) 782-0414
- **Mailing address:** 725A KENTON ST, BOWLING GREEN, KY 42101-4917
- **Mailing address phone:** (270) 782-0414
- **Mailing address fax:** (270) 782-0414

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 1223G0001X | General Practice Dentistry | 5625 | KY | Yes |

## Other

- **Enumeration date:** 05/01/2007
- **Last updated:** 08/22/2020

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 6190072600 | — | KY |