Provider Demographics
NPI:1730634338
Name:WALDEN, SETH (DMD)
Entity type:Individual
Prefix:
First Name:SETH
Middle Name:
Last Name:WALDEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2979 N LAKE PKWY STE 100
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31909-2575
Mailing Address - Country:US
Mailing Address - Phone:706-257-7374
Mailing Address - Fax:
Practice Address - Street 1:2979 N LAKE PKWY STE 100
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31909-2575
Practice Address - Country:US
Practice Address - Phone:706-257-7374
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-24
Last Update Date:2025-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN1224321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice