Provider Demographics
NPI:1164522579
Name:WALGREN, JAMES C (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:C
Last Name:WALGREN
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 1:1122 ROCKDALE RD
Mailing Address - Street 2:
Mailing Address - City:DUBUQUE
Mailing Address - State:IA
Mailing Address - Zip Code:52003
Mailing Address - Country:US
Mailing Address - Phone:556-556-2650
Mailing Address - Fax:563-556-2331
Practice Address - Street 1:1122 ROCKDALE RD
Practice Address - Street 2:
Practice Address - City:DUBUQUE
Practice Address - State:IA
Practice Address - Zip Code:52003-7285
Practice Address - Country:US
Practice Address - Phone:556-556-2650
Practice Address - Fax:563-556-2331
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA063601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0150763Medicaid