Mark O Waller, D.D.S.

NPI #1679670046 in Sussex, Wisconsin

Provider Information

NPI Number
1679670046
Entity Type
Individual
Name
Mark O Waller, D.D.S.
Gender
Not Specified
Sole Proprietor
Yes
Primary Specialty
Dentist - General Practice
Credential
D.D.S.
Enumeration Date
Sep 20, 2006
Last Updated
Jul 8, 2007

Practice Location

Address
N63 W23401 MAIN ST
City
Sussex
ZIP Code
53089-0229
Phone
(262) 246-6806

Specialties & Taxonomy Codes

Specialty
Dentist - General PracticeGeneral Practice

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