Brenden Walter, DDS

Primary specialty

DentistTaxonomy code 122300000X

License

2901601826 Issued in MI

Practice address

Great Lakes Bay Health Centers
200 N Caledonia
Owosso, MI 48867

Phone

(989) 720-4822

Fax

(989) 921-4959

NPI assigned

Apr 24, 2023

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: brenden.walter.1@27771.direct.athenahealth.com

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Great Lakes Bay Health Centers

  • Obstetrics & Gynecology Physician
  • Saginaw, MI
  • NPI 1871684761
  Medicare reassignment NPD
• Great Lakes Bay Health Centers

  • Federally Qualified Health Center (FQHC)
  • Midland, MI
  • NPI 1609609536
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692057600000",
    "number": "1710674254",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "501 LAPEER AVE",
            "city": "SAGINAW",
            "state": "MI",
            "postal_code": "486071203",
            "telephone_number": "989-720-4188",
            "fax_number": "989-921-4959"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "GREAT LAKES BAY HEALTH CENTERS",
            "address_2": "200 N CALEDONIA",
            "city": "OWOSSO",
            "state": "MI",
            "postal_code": "48867",
            "telephone_number": "989-720-4822",
            "fax_number": "989-921-4959"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALTER",
        "first_name": "BRENDEN",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-08-15",
        "certification_date": "2023-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MI",
            "license": "2901601826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Rosemarie E Walch, DO
• Walgreen Co
• Brett Michael Walker, DO
• Caitlin Marie Walker, OT
• Ashley Walsh, BSHA
• Erin Elizabeth Walter
• Tatiana Walters
• Aimee Waltz
• Kenneth P Walworth III, PA-C
• Melissa Walz, BA

• Dentist in Owosso, MI
• Providers in Owosso, MI by specialty
• Dentist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.