NPIMap

Organization Active NPI

Gary K. Walden DMD & Brenda C. Walden DMD

  • General Practice Dentistry
  • Bowling Green, KY
National Provider Identifier
1962623496
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
5625 Issued in KY
Legal business name
GARY K. WALDEN DMD & BRENDA C. WALDEN DMD
Practice address
725A Kenton St
Bowling Green, KY 42101-4917
Phone
(270) 782-0414
Fax
(270) 782-0414
NPI assigned
May 1, 2007
Last updated
Aug 22, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
Dr. Gary K Walden, D.M.D.NPI 1346377256
Title
Owner
Phone
(270) 782-0414

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 5625 KY Primary

Addresses

Primary practice location

725A Kenton St
Bowling Green, KY 42101-4917

Mailing address

725A Kenton St
Bowling Green, KY 42101-4917
Phone (270) 782-0414

Other identifiers 1

IdentifierTypeStateIssuer
6190072600MedicaidKY

National Provider Directory

National Provider Directory

Locations

725 Kenton St
#A
Bowling Green, KY 42101
Phone (270) 782-0414

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1177977600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1962623496",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "725A KENTON ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014917",
            "telephone_number": "270-782-0414",
            "fax_number": "270-782-0414"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "725A KENTON ST",
            "city": "BOWLING GREEN",
            "state": "KY",
            "postal_code": "421014917",
            "telephone_number": "270-782-0414",
            "fax_number": "270-782-0414"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GARY K. WALDEN DMD & BRENDA C. WALDEN DMD",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-01",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "WALDEN",
        "authorized_official_first_name": "GARY",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "270-782-0414",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "D.M.D."
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "5625",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6190072600",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Bowling Green, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.