Provider Demographics
NPI:1689727109
Name:THAL, WALTER FRED (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:FRED
Last Name:THAL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
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Mailing Address - Street 1:1 LAKE ST
Mailing Address - Street 2:BUILDING B
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06052-1396
Mailing Address - Country:US
Mailing Address - Phone:860-224-2419
Mailing Address - Fax:860-224-3095
Practice Address - Street 1:1 LAKE ST
Practice Address - Street 2:BUILDING B
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06052-1396
Practice Address - Country:US
Practice Address - Phone:860-224-2419
Practice Address - Fax:860-224-3095
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT052561223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry