Provider Demographics
NPI:1043292162
Name:WALTERS, WILLIAM C (DDS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:C
Last Name:WALTERS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7000 ADAMS ST
Mailing Address - Street 2:STE 140
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527-7564
Mailing Address - Country:US
Mailing Address - Phone:630-887-1987
Mailing Address - Fax:630-887-1963
Practice Address - Street 1:7000 ADAMS ST
Practice Address - Street 2:STE 140
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527-7564
Practice Address - Country:US
Practice Address - Phone:630-887-1987
Practice Address - Fax:630-887-1963
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19014429122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004128Medicaid