Provider Demographics
NPI:1376564229
Name:WAHAN, SERV (DMD, MD)
Entity Type:Individual
Prefix:DR
First Name:SERV
Middle Name:
Last Name:WAHAN
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7021 117TH PL NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-8461
Mailing Address - Country:US
Mailing Address - Phone:425-890-8424
Mailing Address - Fax:425-822-0739
Practice Address - Street 1:7021 117TH PL NE
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-8461
Practice Address - Country:US
Practice Address - Phone:425-890-8424
Practice Address - Fax:425-822-0739
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105171223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery