Provider Demographics
NPI:1093750937
Name:WAHLEN, CURTIS D (DMD)
Entity Type:Individual
Prefix:DR
First Name:CURTIS
Middle Name:D
Last Name:WAHLEN
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 1:2480 SO. HIGHWAY 89
Mailing Address - Street 2:SUITE A
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-4152
Mailing Address - Country:US
Mailing Address - Phone:435-723-9443
Mailing Address - Fax:435-723-9445
Practice Address - Street 1:2480 SO. HIGHWAY 89
Practice Address - Street 2:SUITE A
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-4152
Practice Address - Country:US
Practice Address - Phone:435-723-9443
Practice Address - Fax:435-723-9445
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2007-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT530032999231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice