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Individual
DR. JAMES ALFRED WALZ
Active
Individual
DR. JAMES ALFRED WALZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
7943
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1243500
MN REVENUE TAXPAYER ID
MN
01
—
36315WA
BLUE CROSS BLUE SHIELD
MN
01
—
5030361
MN TAX ID NUMBER
MN
Enumeration date
07/27/2006
Last updated
07/09/2007
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