Provider Demographics
NPI:1942286497
Name:SHAGHALIAN, WALTER RAYMOND
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:RAYMOND
Last Name:SHAGHALIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 PAWTUCKET AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-1704
Mailing Address - Country:US
Mailing Address - Phone:401-438-4964
Mailing Address - Fax:401-434-6021
Practice Address - Street 1:1002 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1704
Practice Address - Country:US
Practice Address - Phone:401-438-4964
Practice Address - Fax:401-434-6021
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIDEN015341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice