Provider Demographics
NPI:1053488080
Name:MCMAHON WAHLER, KATHLEEN LYNN (DDS)
Entity Type:Individual
Prefix:DR
First Name:KATHLEEN
Middle Name:LYNN
Last Name:MCMAHON WAHLER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 MILLERSPORT HWY
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14221-2900
Mailing Address - Country:US
Mailing Address - Phone:716-630-5085
Mailing Address - Fax:716-630-5086
Practice Address - Street 1:1321 MILLERSPORT HWY
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-2900
Practice Address - Country:US
Practice Address - Phone:716-630-5085
Practice Address - Fax:716-630-5086
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2015-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0430251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice