Mark Robert Vande Walle is a Green Bay, Wisconsin based Dentist who is specialized in
Dentistry. He does not accept the Medicare-approved amount. Patients will be billed for the treatment. Active license number of Mark Robert Vande Walle is
003209 for Dentistry in Wisconsin. His current practice location is
1711 Shawano Ave, Green Bay. Patients can reach him at
920-494-9541.
Mark Robert Vande Walle is the primary dental care provider for patients of all ages. He is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
Complete Profile:
Mark Robert Vande Walle speciality, credentials, practice address, contact phone number and fax are as below.
Patients can directly walk in or can call on the below given phone number for appointment.
| Name: | Mark Robert Vande Walle |
| Specialization: | Dentist |
| Gender: | Male |
| Credentials: | DDS |
| Accepts Medicare Assignment: | No |
| Practice Address: | 1711 Shawano Ave, Green Bay,
Wisconsin, 54303 |
| Phone: | 920-494-9541 |
Professional Identification Codes:
NPI number stands for National Provider Identifier which is a unique 10-digit identification number issued to health care providers in the United States by the Centers for Medicare and Medicaid Services (CMS).
NPI details are as mentioned below.
| NPI Number: | 1083749774 |
| NPI Enumeration Date: | 22 Feb, 2007 |
| NPI Last Update On: | 08 Jul, 2007 |
Medical Licenses:
Doctors can have one or more medical licenses for different specialities in the same state or different states. Related medical licenses for Mark Robert Vande Walle are as mentioned below.
| License Number | Specialization | State | Status | |
| 003209 | Dentistry | Wisconsin | Primary | |
Other Medical Identifiers:
Other legacy medical identifiers associated with Mark Robert Vande Walle such as Medicaid, Medicare PIN, NSC, UPIN etc. are mentioned as below.
| Identifier | Type | State | Issuer |
| 33456900 | Medicaid | Wisconsin | |
Business mailing address can be used for mailing purpose only, for visiting purpose patients need to refer above mentioned address.
| Address: | 1711 Shawano Ave,
Green Bay, Wisconsin |
| Zip: | 54303 |
| Phone Number: | 920-494-9541 |
Patients can reach Mark Robert Vande Walle at
1711 Shawano Ave, Green Bay, Wisconsin or can
call to book an appointment on 920-494-9541.
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**Data of this site is collected from Medicare & Medicaid Services (CMS) and NPPES. Last updated on
08 December, 2025.