Provider Demographics
NPI:1922417666
Name:NAI ANNIE WALTER DDS,PC
Entity Type:Organization
Organization Name:NAI ANNIE WALTER DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NAI
Authorized Official - Middle Name:ANNIE
Authorized Official - Last Name:WALTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:708-352-1830
Mailing Address - Street 1:6335 JOLIET RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:COUNTRYSIDE
Mailing Address - State:IL
Mailing Address - Zip Code:60525-7427
Mailing Address - Country:US
Mailing Address - Phone:708-352-1830
Mailing Address - Fax:708-482-4881
Practice Address - Street 1:6335 JOLIET RD
Practice Address - Street 2:SUITE 200
Practice Address - City:COUNTRYSIDE
Practice Address - State:IL
Practice Address - Zip Code:60525-7427
Practice Address - Country:US
Practice Address - Phone:708-352-1830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-07
Last Update Date:2014-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019017341261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental