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Mark O Waller, DDS
General Practice Dentistry in Sussex, Wisconsin
NPI 1679670046

Mark O Waller is a General Practice Dentistry based in Sussex, WI and is specialized in General Practice. Mark O Waller practices in Sussex, WI and has the professional credentials of DDS. The NPI Number for Mark O Waller is 1679670046 and holds a License No. 3012 (Wisconsin).

The current practice location address for Mark O Waller is N63 W23401 Main St, Sussex, WI and can be reached out via phone at 262-246-6806 and via fax at 262-246-6892.

Location: N63 W23401 Main St, Sussex, WI, 53089-0229
Profile Details Legacy Identifiers Practice Address Mailing Address Primary Taxonomy
person
Provider Profile Details
NPI Number
1679670046
Provider Name
Mark O Waller
Credential
DDS
Provider Entity Type
Individual
Gender
Male
Address
N63 W23401 Main St, Sussex, WI, 53089-0229
Phone Number
262-246-6806
Fax Number
262-246-6892
Provider Enumeration Date
09/20/2006
Last Update Date
03/08/2024
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Provider's Legacy Identifiers
Identifier Type State Issuer
799832 01 UNITED CONCORDIA
institution
Provider Business Practice Location Address Details
Address
N63 W23401 Main St
City
Sussex
State
Wisconsin
Zip
53089-0229
Phone Number
262-246-6806
Fax Number
262-246-6892
person
Provider Business Mailing Address Details
Address
N63 W23401 Main St
City
Sussex
State
Wisconsin
Zip
53089-0229
Phone Number
262-246-6806
Fax Number
262-246-6892
person
Provider's Taxonomy Details 1
Type
Dental Providers
Classification
Dentist
Speciality
General Practice
Taxonomy
1223G0001X
License No.
3012 (Wisconsin)
Definition
A general dentist is the primary dental care provider for patients of all ages. The general dentist is responsible for the diagnosis, treatment, management and overall coordination of services related to patients' oral health needs.
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