Provider Demographics
NPI:1083068027
Name:WAHLE, WILLIAM MAXWELL (DDS, MS)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MAXWELL
Last Name:WAHLE
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 WEST RD STE 200
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2341
Mailing Address - Country:US
Mailing Address - Phone:410-296-0136
Mailing Address - Fax:
Practice Address - Street 1:110 WEST RD STE 200
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2341
Practice Address - Country:US
Practice Address - Phone:410-296-0136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-15
Last Update Date:2020-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IADDS-09045122300000X
MD159221223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD15922OtherMARYLAND DENTAL BOARD