Healthcare Provider Details

I. General information

NPI: 1437261922
Provider Name (Legal Business Name): WILLIAM C WALTERS DDS LTD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7000 ADAMS STREET 140
WILLOWBROOK IL
60527
US

IV. Provider business mailing address

7000 ADAMS STREET 140
WILLOWBROOK IL
60527
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 Number
License Number StateIL

VIII. Authorized Official

Name: DR. WILLIAM C WALTERS
Title or Position: DENTIST
Credential: DDS
Phone: 630-887-1987