Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Mark Robert Vande Walle, DDS

Individual provider Dentist · NPI 1083749774

Mark Robert Vande Walle, DDS is a Dentist in Green Bay, Wisconsin. Licensed in Wisconsin. Registered with an NPI since 2007.

Licensed in
WI
In the registry since
2007
What do these letters mean?
DDS — Doctor of Dental Surgery
A dentist. DDS and DMD are the same qualification — universities choose which title to award.

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Practice location Address checks out

1711 Shawano Ave
Green Bay, WI 54303
Phone: (920) 494-9541
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Dentist (primary) Taxonomy 122300000X · Licence 003209 (WI)

Record details

NPI number1083749774
Entity typeIndividual (Type 1)
GenderMale
Credentials DDS
Sole proprietorNo
NPI enumeratedFebruary 22, 2007
Last updated in NPPESJuly 8, 2007
Mailing address1711 Shawano Ave, Green Bay, WI 54303

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