Provider Demographics
NPI:1992864987
Name:JAMES, WALTER ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:ROBERT
Last Name:JAMES
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 1:133 S LINCOLN ST
Mailing Address - Street 2:
Mailing Address - City:BRAIDWOOD
Mailing Address - State:IL
Mailing Address - Zip Code:60408-1945
Mailing Address - Country:US
Mailing Address - Phone:815-458-2221
Mailing Address - Fax:815-458-3266
Practice Address - Street 1:133 S LINCOLN ST
Practice Address - Street 2:
Practice Address - City:BRAIDWOOD
Practice Address - State:IL
Practice Address - Zip Code:60408-1945
Practice Address - Country:US
Practice Address - Phone:815-458-2221
Practice Address - Fax:815-458-3266
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist