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

Q: 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.

Q: What is Mark Vande Walle's specialty?

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

Q: When was this NPI record last updated?

The NPPES record for Mark Vande Walle was last updated on July 8, 2007. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 19 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

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: August 16, 2026.

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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

Phone(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

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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.

MISS ANDREA NICOLE STANKE RDH

Dental Hygienist