MARK ROBERT VANDE WALLE DDS
NPI 1083749774
Dentist in Green Bay, WI

Active since February 22, 2007
1711 SHAWANO AVE, GREEN BAY, WI 54303(920) 494-9541 Get Directions Write a Review

NPPES record last updated: July 8, 2007. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Mark Robert Vande Walle Dds NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARK ROBERT VANDE WALLE DDS (NPI 1083749774) is an individual dentist in Green Bay, Wisconsin, licensed in Wisconsin (003209) and active in the NPI registry since February 2007.

NPPES Registry Identity

NPI1083749774
Entity TypeIndividualMale
Primary Taxonomy122300000X
Provider Legal NameMARK ROBERT VANDE WALLECredential: DDS
Location Address1711 SHAWANO AVEGreen Bay, WI 54303
Mailing Address1711 Shawano AveGreen Bay, WI 54303 · (920) 494-9541
Sole ProprietorNo
Enumeration DateFebruary 22, 2007
Last NPPES UpdateJuly 8, 2007
NPI 1083749774 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyDentistDental Providers
Taxonomy Code122300000X
License Licensed in WI · 003209
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.

1711 SHAWANO AVE, Green Bay, WI 54303

Other Identifiers 1

Medicaid33456900WI

Other Providers at the Same Location NPPES 13

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Dental Hygienist
1711 SHAWANO AVE
GREEN BAY, WI 54303
Dental Hygienist
1711 SHAWANO AVE
GREEN BAY, WI 54303
Dentist
1711 SHAWANO AVE
GREEN BAY, WI 54303
Dentist
1711 SHAWANO AVE
GREEN BAY, WI 54303
Clinic/Center (Dental)
1711 SHAWANO AVE
GREEN BAY, WI 54303
Dental Hygienist
1711 SHAWANO AVE
GREEN BAY, WI 54303
Dental Hygienist
1711 SHAWANO AVE
GREEN BAY, WI 54303
Dentist
1711 SHAWANO AVE
GREEN BAY, WI 54303

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Mark Vande Walle's NPI number?

The NPI number for Mark Vande Walle is 1083749774. It was assigned to this individual provider in the NPPES registry on February 22, 2007.

Where is Mark Vande Walle located?

Mark Vande Walle practices at 1711 Shawano Ave, Green Bay, WI 54303. The listed phone number is (920) 494-9541.

What is Mark Vande Walle's specialty?

The primary specialty registered for this NPI is Dentist with taxonomy code 122300000X.

When was this NPI record last updated?

The NPPES record for Mark Vande Walle was last updated on July 8, 2007. NPI Profile syncs with the weekly NPPES data releases published by CMS.