1437261922 NPI number — WILLIAM C WALTERS DDS LTD

Table of content: MICHELLE CHRISTINE CAPIZZI M.D. (NPI 1508815457)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437261922 NPI number — WILLIAM C WALTERS DDS LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WILLIAM C WALTERS DDS LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WILLIAM C WALTER DDS
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437261922
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 ADAMS STREET
Provider Second Line Business Mailing Address:
140
Provider Business Mailing Address City Name:
WILLOWBROOK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60527
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
630-887-1987
Provider Business Mailing Address Fax Number:
630-887-1963

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 ADAMS STREET
Provider Second Line Business Practice Location Address:
140
Provider Business Practice Location Address City Name:
WILLOWBROOK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60527
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
630-887-1987
Provider Business Practice Location Address Fax Number:
630-887-1963
Provider Enumeration Date:
08/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTERS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
630-887-1987

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1004128 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".




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