Provider Demographics
NPI:1194038703
Name:WAHL, ROBERT WESLEY III (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WESLEY
Last Name:WAHL
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3518 SAINT LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19606-2357
Mailing Address - Country:US
Mailing Address - Phone:610-779-5876
Mailing Address - Fax:
Practice Address - Street 1:3518 SAINT LAWRENCE AVE
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-2357
Practice Address - Country:US
Practice Address - Phone:610-779-5876
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-24
Last Update Date:2010-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS019061L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice