Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Dr. Jack Glenn Walz, DDS

Individual provider Dentist · NPI 1427166008

Dr. Jack Glenn Walz, DDS is an Oral Surgery in East Peoria, Illinois. Qualified in 1981, 45 years ago. Licensed in Illinois.

Years since qualifying
45
Licensed in
IL
In the registry since
2006
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

See every abbreviation used in this directory →

Practice location Address checks out

731 Sabrina Dr Ste A
East Peoria, IL 61611
Phone: (309) 699-1300
Fax: (309) 699-5399
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 019021995 (IL)

Record details

NPI number1427166008
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedAugust 25, 2006
Last updated in NPPESMarch 12, 2018
Mailing address731 Sabrina Dr, Unit A, East Peoria, IL 61611-3582

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyORAL SURGERY
Medical schoolOTHER
Graduated 1981 (45 years in practice)
Accepts Medicare assignment Not indicated

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