Individual
DR. BRADLEY CLAY WALDEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
450 OLD ABE RD, LAC DU FLAMBEAU, WI 54538-9682
(715) 588-4287
Mailing address
9053 TIMBERLANE RD, WOODRUFF, WI 54568-9603
(715) 892-7808
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
6262
WI
1223G0001X
General Practice Dentistry
8307
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
33825300
—
WI
Enumeration date
04/11/2007
Last updated
07/01/2008
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