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General NPI Number Information
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NPI Number | 1922417666
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Entity Type | Organization
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Legal Business Name | NAI ANNIE WALTER DDS,PC
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Dates
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Enumeration Date | 08/07/2014
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Last Update Date | 08/07/2014
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Provider Practice Location Address
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Address Line | 6335 JOLIET RD SUITE 200
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-7427
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Country | US
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Telephone | 708-352-1830
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Fax |
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Provider Business Mailing Address
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Address Line | 6335 JOLIET RD SUITE 200
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City | COUNTRYSIDE
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State | IL
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Zip | 60525-7427
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Country | US
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Telephone | 708-352-1830
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Fax | 708-482-4881
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NAI ANNIE WALTER
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Credential |
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Telephone | 708-352-1830
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 019017341
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License Number State | IL
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