Individual
DR. JAMES ALFRED WALZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
338 W BROADWAY, PLAINVIEW, MN 55964-1256
(507) 534-2675
Mailing address
338 W BROADWAY, PLAINVIEW, MN 55964-1256
(507) 534-2675
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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