Provider Demographics
NPI:1558668756
Name:WALTER D. FLOR, D.D.S., LTD.
Entity Type:Organization
Organization Name:WALTER D. FLOR, D.D.S., LTD.
Other - Org Name:HOMEWOOD-FLOSSMOOR DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:D
Authorized Official - Last Name:FLOR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:708-799-0660
Mailing Address - Street 1:18340 GOVERNORS HWY
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2910
Mailing Address - Country:US
Mailing Address - Phone:708-799-0660
Mailing Address - Fax:
Practice Address - Street 1:18340 GOVERNORS HWY
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-2910
Practice Address - Country:US
Practice Address - Phone:708-799-0660
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-24
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL060001701261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental