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General NPI Number Information
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NPI Number | 1437178381
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Entity Type | Individual
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Provider Name | JASON ERIC WALDEN DMD,MS
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Gender | Male
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Dates
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Enumeration Date | 07/19/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 6905 BURLINGTON PIKE SUITE A
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City | FLORENCE
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State | KY
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Zip | 41042
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Country | US
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Telephone | 859-647-0006
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Fax | 859-647-0634
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Provider Business Mailing Address
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Address Line | 10658 BRIDLEPATH LN
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City | UNION
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State | KY
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Zip | 41091-9519
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Country | US
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Telephone | 859-647-0006
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Fax | 859-647-0634
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223E0200X
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Taxonomy Name | Endodontics
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License Number | 7724
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License Number State | KY
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