Provider Demographics
NPI:1356788442
Name:COREY J WALTHER DDS LTD
Entity type:Organization
Organization Name:COREY J WALTHER DDS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:COREY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WALTHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:847-882-3683
Mailing Address - Street 1:80 W HILLCREST BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SCHAUMBURG
Mailing Address - State:IL
Mailing Address - Zip Code:60195-3106
Mailing Address - Country:US
Mailing Address - Phone:847-882-3683
Mailing Address - Fax:847-882-6982
Practice Address - Street 1:80 W HILLCREST BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:SCHAUMBURG
Practice Address - State:IL
Practice Address - Zip Code:60195-3106
Practice Address - Country:US
Practice Address - Phone:847-882-3683
Practice Address - Fax:847-882-6982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-29
Last Update Date:2013-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190216031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty