Data from the NPPES registry. May not reflect recent changes — verify at nppes.cms.hhs.gov.
MARK O WALLER, D.D.S.
Active Sole ProprietorMARK O WALLER, D.D.S. is a General Dentistry healthcare provider located in SUSSEX, Wisconsin. NPI 1679670046 is currently active in the NPPES registry. Verify at CMS.
General Dentistry · SUSSEX, WI
Registration Details
- NPI Number
- 1679670046
- Provider Type
- Individual
- Gender
- Male
- NPI Issued
- Sep 20, 2006 (19.91597603618 yrs)
- Last Updated
- Jul 8, 2007
- License
-
3012 (WI)
- Sole Proprietor
- Yes
Practice Information
- Address
-
N63 W23401 MAIN STSUSSEX, WI, 530890229Browse WI providers · Browse ZIP 53089
- Phone
- 2622466806
- Fax
- 2622466892
- Primary Specialty
-
General Dentistry
1223G0001X
Other General Dentistry Providers in SUSSEX, WI
| Name | Credential | NPI |
|---|---|---|
| JOHN C MAGNUSSON | DDS | 1467530477 |
| HEIDI ANN DAUB | DDS | 1164613923 |
| DR. MARY VEZZETTI | DDS | 1306095922 |
| ERIK TOY | — | 1962980425 |
Data sourced from the NPPES National Provider Identifier registry. This information is for informational purposes only and is not a substitute for verifying credentials with the appropriate licensing authority. For official verification, use the NPPES NPI Registry or the relevant state medical board.