DR. Jack Glenn Walz, DDS

NPI #1427166008 in East Peoria, Illinois

Provider Information

NPI Number: 1427166008
Entity Type: Individual
Name: DR. Jack Glenn Walz, DDS
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Dentist
Credential: DDS
Enumeration Date: Aug 25, 2006
Last Updated: Mar 12, 2018

Practice Location

Address: 731 SABRINA DRIVE
Address 2: STE A
City: East Peoria
State: Illinois
ZIP Code: 61611
Phone: (309) 699-1300

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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