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General NPI Number Information
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NPI Number | 1053737445
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Entity Type | Individual
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Provider Name | MARK D. VALROSE D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 03/10/2014
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Last Update Date | 04/02/2020
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Provider Practice Location Address
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Address Line | 80 COLUMBUS RD
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City | ATHENS
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State | OH
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Zip | 45701-1312
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Country | US
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Telephone | 847-594-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 20823 W CHARTWELL DR
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City | KILDEER
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State | IL
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Zip | 60047-8582
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 30.025353
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | GA
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