Dr Mary M Waller, DDS is a medicare enrolled "Dentist" provider in Genoa City, Wisconsin. Her current practice location is
501 Freeman St., Genoa City, Wisconsin. You can reach out to her office (for appointments etc.) via phone at
(262) 279-6432.
Dr Mary M Waller is licensed to practice in Wisconsin (license number 2865) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1679772669.
Healthcare Provider's Profile
Full Name | Dr Mary M Waller |
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Gender | Female |
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Speciality | Dentist |
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Location | 501 Freeman St., Genoa City, Wisconsin |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1679772669
- Provider Enumeration Date: 07/11/2007
- Last Update Date: 07/11/2007
Medicare PECOS Information:
- PECOS PAC ID: 2365749264
- Enrollment ID: I20160321000529
Medical Identifiers
Medical identifiers for Dr Mary M Waller such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1679772669 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
122300000X | Dentist | 2865 (Wisconsin) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Dr Mary M Waller is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Dr Mary M Waller, DDS Po Box 159, Genoa City, WI 53128-0159 Ph: (262) 279-6432 | Dr Mary M Waller, DDS 501 Freeman St., Genoa City, WI 53128-0159 Ph: (262) 279-6432 |
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