MARK O WALLER

SUSSEX, WI
NPI1679670046
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy1223G0001X Dentist, General Practice
(Licence: WI  3012)
Enumeration Date2006-09-20
Last Update Date2007-07-08
Business Address
-- MARK O WALLER D.D.S.
N63 W23401 MAIN ST
SUSSEX, WI 53089-0229
Phone number: 262-246-6806
Mailing Address
-- MARK O WALLER D.D.S.
PO BOX 229
SUSSEX, WI 53089-0229
Phone number: 262-246-6806
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