MARK ROBERT VANDE WALLE


Address: 1711 Shawano Ave, Green Bay, WI 54303
Phone: 9204949541

MARK ROBERT VANDE WALLE (NPI# 1083749774) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1083749774
Entity Type Individual
Full Name MARK ROBERT VANDE WALLE
Credential DDS
Practice Address 1711 Shawano Ave
Green Bay
WI 54303
Practice Telephone 9204949541
Mailing Telephone 9204949541
Enumeration Date 2007-02-22
Last Update Date 2007-07-08
Gender Code M
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 122300000X Dentist 003209 WI Dental Providers

Other Provider Identifier

State Issuer Identifier Type Code
WI 33456900 05

Office Location

Street Address 1711 SHAWANO AVE
City GREEN BAY
State WI
Zip Code 54303

Providers in the same location

NPI Name Taxonomy Address Enumeration
1568597243 Daniel Lloyd Baker Jr. Dentist 1711 Shawano Ave, Green Bay, WI 54303 2007-02-22
1124326962 Andrea Nicole Becks Dental Hygienist 1711 Shawano Ave, Green Bay, WI 54303-3215 2011-03-02
1700105806 Nicholas Mattila Dentist 1711 Shawano Ave, Green Bay, WI 54303-3215 2010-05-28
1932227311 Lorie Ann Salentine Dental Hygienist 1711 Shawano Ave, Green Bay, WI 54303 2007-03-26
1780711812 Melissa Lynn Rukamp Dental Hygienist 1711 Shawano Ave, Green Bay, WI 54303-3215 2007-02-27
1588790489 Lisa M Hekenberger Dental Hygienist 1711 Shawano Ave, Green Bay, WI 54303 2007-02-26
1336274018 Courtney Lynn Christensen Dental Hygienist 1711 Shawano Ave, Green Bay, WI 54303 2007-02-22
1528193208 Tami Jay Sargent Dental Hygienist 1711 Shawano Ave, Green Bay, WI 54303 2007-02-22
1326173006 Dental Arts Associates of Green Bay Ltd Clinic/Center 1711 Shawano Ave, Green Bay, WI 54303 2007-02-22
1316072093 Zachary Adam Graf Dentist 1711 Shawano Ave, Green Bay, WI 54303 2007-02-22
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1952921033 Ashley Marie Vandermoss Social Worker 1601 W Mason Street, Green Bay, WI 54303 2020-04-20
1598307423 Jean Marie Castaneda Case Manager/Care Coordinator 2517 N. Court, Green Bay, WI 54303 2019-10-11
1215579552 Integrated Treatment Centers, LLC Clinic/Center 2311 W Mason Street, Green Bay, WI 54303 2019-10-08
1003460551 Affordable Dentures & Implants - Green Bay, S.c. Dentist 1800-c W. Mason Street, Green Bay, WI 54303 2019-08-01
1164940375 Kaeley Rae Blaney Student in an Organized Health Care Education/Training Program 2088 Memorial Drive #208, Green Bay, WI 54303 2017-09-07
1518498047 Treatment Providers LLC Clinic/Center 2731 N Packerland Dr Ste A, Green Bay, WI 54303 2017-03-26
1851840565 Back To Balance Chiropractic, LLC Chiropractor 110 Packerland Drive, Suite B, Green Bay, WI 54303 2016-09-23
1710361001 Matthew Lemay Acupuncturist 727 E Walnut, Suite B2, Green Bay, WI 54303 2015-07-16
1144600149 Carrie Jean Banaszak Counselor 1039 Mason Street, Green Bay, WI 54303 2015-06-04
1174921993 Kensey Meyer Occupational Therapy Assistant 1555 Dousman Road, Seymour, WI 54303 2014-12-10
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Taxonomy Information

Taxonomy Code 122300000X
Grouping Dental Providers
Classification Dentist

Taxonomy Definition

A dentist is a person qualified by a doctorate in dental surgery (D.D.S.) or dental medicine (D.M.D.), licensed by the state to practice dentistry, and practicing within the scope of that license. There is no difference between the two degrees: dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist.
Notes: Source: Council on Dental Education and Licensure, American Dental Association

Providers in the same taxonomy and city

NPI Name Taxonomy Address Enumeration
1184240236 Casey Nan Messer Dentist 2805 Libal St Ste B, Green Bay, WI 54301-2888 2020-06-24
1003460551 Affordable Dentures & Implants - Green Bay, S.c. Dentist 1800-c W. Mason Street, Green Bay, WI 54303 2019-08-01
1275013641 David Alan Pass Dentist 844 Willard Dr # A, Green Bay, WI 54304-5265 2018-08-15
1831691872 Melanie Hammerbeck Dentist 1756 Cardinal Ln, Green Bay, WI 54313 2018-03-06
1114453024 Juan Sebastian Munoz Dentist 709 S Oneida St Ste 6, Green Bay, WI 54304-2475 2017-05-11
1851844161 Green Bay Family Dental LLC Dentist 2609 Development Dr., Green Bay, WI 54311 2016-08-03
1043663321 Thuy Nguyen Dentist 331 N Broadway, Green Bay, WI 54303-2701 2016-07-21
1629448170 Simerjeet Kaur Dentist 1931 Main St, Green Bay, WI 54302-3920 2015-09-28
1811307408 Adam Pasono Dentist 2313 S Webster Ave, Green Bay, WI 54301-2159 2014-05-05
1972764553 S. Patrick Maraka Dentist 2830 Curry Ct Ste 1, Green Bay, WI 54311-4877 2008-06-17
Find all providers in GREEN BAY

Competitor

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City GREEN BAY
Zip Code 54303

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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