Vande Walle, Mark Robert
Vande Walle, Mark Robert is an individual health care provider with primary practice located at 1711 Shawano Ave , Green Bay WI 54303. He recently has only one registered license in Dental Providers / Dentist, which is considered as his primary health care specialty. Vande Walle, Mark Robert can be contacted via phone (920) 494-9541.Contact Information
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Dental Providers / Dentist | 122300000X | 003209 | Wisconsin |
Profile Details
| NPI number | 1083749774 |
|---|---|
| LBN Legal business name | Vande Walle, Mark Robert |
| Credentials | Doctor of Dental Surgery (DDS) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Feb 22nd, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1083749774 | NPPES |
| Wisconsin | MEDICAID | 33456900 |
Popular Providers
-
Miller, Thomas J
2805 Libal St. Ste. C, Green Bay WI 54301-2877 -
Brusky, David J.
410 Security Blvd , Green Bay WI 54313-9705 -
Thompson, David Charles
1711 Shawano Ave , Green Bay WI 54303 -
Gesker, Richard W.
430 Main St , Green Bay WI 54301-5115 -
Kollath, Paul A
2805 Libal St. Ste. C, Green Bay WI 54301-2877 -
Lasnoski, Joseph William
138 Siegler St , Green Bay WI 54303 -
Carter, Jill Mary
2926 Finger Rd , Green Bay WI 54311-7548 -
Villwock, Robert Melvin
1401 Kingston Terrace , Green Bay WI 54302-5405