Provider Demographics
NPI:1912194572
Name:WALKER, JEFFREY T (DDS,MS)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:T
Last Name:WALKER
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18130 HALSTED ST
Mailing Address - Street 2:
Mailing Address - City:HOMEWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60430-2507
Mailing Address - Country:US
Mailing Address - Phone:708-799-2550
Mailing Address - Fax:708-799-1094
Practice Address - Street 1:540 BUTTERNUT TRL
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1076
Practice Address - Country:US
Practice Address - Phone:630-865-9002
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-27
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL021-0017051223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics