MEDICARE: DR. ALFRED FREEMAN. WALDEN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D22583	CA

General Provider Information

NPI Number	:	1013199827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALFRED FREEMAN. WALDEN D.D.S.

Provider Business Mailing Address
First Line	:	300 PRISON RD
Second Line	:
City	:	REPRESA
State	:	CA
Zip	:	95671-3001
Country	:	US
Telephone Number	:	916-985-2561
Fax Number	:	916-608-3105

Provider Business Practice Location Address
First Line	:	1614 X ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95818-2300
Country	:	US
Telephone Number	:	916-446-1588
Fax Number	:	916-446-1587

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2007
Last Update Date	:	12/04/2007

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