Provider Demographics
NPI:1437261922
Name:WILLIAM C WALTERS DDS LTD
Entity Type:Organization
Organization Name:WILLIAM C WALTERS DDS LTD
Other - Org Name:WILLIAM C WALTER DDS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:C
Authorized Official - Last Name:WALTERS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-887-1987
Mailing Address - Street 1:7000 ADAMS STREET
Mailing Address - Street 2:140
Mailing Address - City:WILLOWBROOK
Mailing Address - State:IL
Mailing Address - Zip Code:60527
Mailing Address - Country:US
Mailing Address - Phone:630-887-1987
Mailing Address - Fax:630-887-1963
Practice Address - Street 1:7000 ADAMS STREET
Practice Address - Street 2:140
Practice Address - City:WILLOWBROOK
Practice Address - State:IL
Practice Address - Zip Code:60527
Practice Address - Country:US
Practice Address - Phone:630-887-1987
Practice Address - Fax:630-887-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1004128Medicaid