Provider Demographics
NPI:1053737445
Name:VALROSE, MARK D (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:D
Last Name:VALROSE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20823 W CHARTWELL DR
Mailing Address - Street 2:
Mailing Address - City:KILDEER
Mailing Address - State:IL
Mailing Address - Zip Code:60047-8582
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:80 COLUMBUS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:OH
Practice Address - Zip Code:45701-1312
Practice Address - Country:US
Practice Address - Phone:847-594-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-10
Last Update Date:2020-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.025353122300000X
GA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program