Healthcare Provider Details

I. General information

NPI: 1871516120
Provider Name (Legal Business Name): WALTER F SHUTTY DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

303 S 6TH ST
WEST NEWTON PA
15089-1331
US

IV. Provider business mailing address

303 S 6TH ST
WEST NEWTON PA
15089-1331
US

V. Phone/Fax

Practice location:
  • Phone: 724-872-4818
  • Fax:
Mailing address:
  • Phone: 724-872-4818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDS019662L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: