Provider Demographics
NPI:1497931315
Name:WALVOORD, BARRY (DDS)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:
Last Name:WALVOORD
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 1:1572 MAPLE AVE.
Mailing Address - Street 2:SUITE 101
Mailing Address - City:EVANSTON
Mailing Address - State:IL
Mailing Address - Zip Code:60201-4668
Mailing Address - Country:US
Mailing Address - Phone:847-328-1700
Mailing Address - Fax:847-328-1782
Practice Address - Street 1:1572 MAPLE AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:EVANSTON
Practice Address - State:IL
Practice Address - Zip Code:60201-4328
Practice Address - Country:US
Practice Address - Phone:847-328-1700
Practice Address - Fax:847-328-1782
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2010-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-0226181223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics