Healthcare Provider Details

I. General information

NPI: 1013199827
Provider Name (Legal Business Name): ALFRED FREEMAN. WALDEN D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2007
Last Update Date: 12/04/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1614 X ST
SACRAMENTO CA
95818-2300
US

IV. Provider business mailing address

300 PRISON RD
REPRESA CA
95671-3001
US

V. Phone/Fax

Practice location:
  • Phone: 916-446-1588
  • Fax: 916-446-1587
Mailing address:
  • Phone: 916-985-2561
  • Fax: 916-608-3105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberD22583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: