Bradley Clay Walden, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

6262 Issued in WI

Practice address

450 Old Abe Rd
Lac Du Flambeau, WI 54538-9682

Phone

(715) 588-4287

NPI assigned

Apr 11, 2007

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WI

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

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

{
    "created_epoch": "1176249600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1214870400000",
    "number": "1841413465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9053 TIMBERLANE RD",
            "city": "WOODRUFF",
            "state": "WI",
            "postal_code": "545689603",
            "telephone_number": "715-892-7808"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "450 OLD ABE RD",
            "city": "LAC DU FLAMBEAU",
            "state": "WI",
            "postal_code": "545389682",
            "telephone_number": "715-588-4287"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WALDEN",
        "first_name": "BRADLEY",
        "middle_name": "CLAY",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-11",
        "last_updated": "2008-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "8307",
            "primary": false
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "WI",
            "license": "6262",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "33825300",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Deborah Gail Swiader, SAC-IT
• Town of Lac Du Flambeau
• Danielle L Turner, RDH
• Patricia A Ustianowski, CADCIII
• Suanne Vannatter, MHNP-BC
• Chrystal Sacheen Wedde, RDH

• General Practice Dentistry in Lac Du Flambeau, WI
• Providers in Lac Du Flambeau, WI by specialty
• General Practice Dentistry in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2008; 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.