Individual
DR. JACK GLENN WALZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
731 SABRINA DRIVE, STE A, EAST PEORIA, IL 61611
(309) 699-1300
(309) 699-5399
Mailing address
731 SABRINA DR, UNIT A, EAST PEORIA, IL 61611-3582
(309) 699-1300
(309) 699-5399
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
019021995
IL
Other
Enumeration date
08/25/2006
Last updated
03/12/2018
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