Provider Demographics
NPI:1487936944
Name:LADA, WALTER JR (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:LADA
Suffix:JR
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 1:351 BUDLONG RD
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-6001
Mailing Address - Country:US
Mailing Address - Phone:401-942-4350
Mailing Address - Fax:401-942-7190
Practice Address - Street 1:351 BUDLONG RD
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-6001
Practice Address - Country:US
Practice Address - Phone:401-942-4350
Practice Address - Fax:401-942-7190
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-12
Last Update Date:2011-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIRI 2006122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist