Walter Matthew Dzialo, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN01869 Issued in RI

Practice address

526 Newport Ave
Pawtucket, RI 02861-3612

Phone

(401) 724-2570

Fax

(401) 724-0199

NPI assigned

Sep 20, 2006

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Family Smiles Dental Care

  • Dental Clinic/Center
  • Pawtucket, RI
  • NPI 1316665979
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1158710400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1487752432",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "37 TASHMOO WAY",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028613712",
            "telephone_number": "401-725-4465",
            "fax_number": "401-725-0158"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "526 NEWPORT AVE",
            "city": "PAWTUCKET",
            "state": "RI",
            "postal_code": "028613612",
            "telephone_number": "401-724-2570",
            "fax_number": "401-724-0199"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DZIALO",
        "first_name": "WALTER",
        "middle_name": "MATTHEW",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-20",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "RI",
            "license": "DEN01869",
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MA",
            "license": "14966",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "WD00135",
            "state": "RI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Durigan, DPT
• Albert Dussault, LICMHC
• Bianca Ann Dutra
• Sylvie Duverseau, LCSW
• Mari-Beth Dziadosz
• East Bay Counsling Center, Inc..
• East Bay Neurology Professional Corporation
• East Side Surgical Group Inc
• Eastern Star EMS
• Charles B. Eaton, MD

• General Practice Dentistry in Pawtucket, RI
• Providers in Pawtucket, RI by specialty
• General Practice Dentistry in Rhode Island

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.