Provider Demographics
NPI:1811191190
Name:WALKER, GEORGE LENWORTH (DDS)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:LENWORTH
Last Name:WALKER
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 1:1515 EAST 52ND PLACE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60615-4390
Mailing Address - Country:US
Mailing Address - Phone:773-752-3832
Mailing Address - Fax:773-752-3879
Practice Address - Street 1:1515 EAST 52ND PLACE
Practice Address - Street 2:SUITE 200
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60615-4390
Practice Address - Country:US
Practice Address - Phone:773-752-3832
Practice Address - Fax:773-752-3879
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL19A150061223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice