Individual
DR. GARY PHILLIP WALDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.M.D.
Contact information
Practice address
148 VINCENT STREET, SMITHS GROVE, KY 42171
(270) 563-4819
(270) 563-4819
Mailing address
PO BOX 370, SMITHS GROVE, KY 42171-0370
(270) 563-4819
(270) 563-4819
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
9168
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
9168
DENTAL INSURANCE
KY
Enumeration date
05/22/2012
Last updated
04/13/2016
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