Healthcare Provider Details

I. General information

NPI: 1043292162
Provider Name (Legal Business Name): WILLIAM C WALTERS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 ADAMS ST STE 140
WILLOWBROOK IL
60527-7564
US

IV. Provider business mailing address

7000 ADAMS ST STE 140
WILLOWBROOK IL
60527-7564
US

V. Phone/Fax

Practice location:
  • Phone: 630-887-1987
  • Fax: 630-887-1963
Mailing address:
  • Phone: 630-887-1987
  • Fax: 630-887-1963

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number19014429
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: