Provider Demographics
NPI:1508899501
Name:WAHL DENTAL GROUP
Entity Type:Organization
Organization Name:WAHL DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DALE
Authorized Official - Middle Name:A
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:303-337-7994
Mailing Address - Street 1:14001 E ILIFF AVE STE 303
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80014-1426
Mailing Address - Country:US
Mailing Address - Phone:303-337-7994
Mailing Address - Fax:303-337-0719
Practice Address - Street 1:14001 E ILIFF AVE STE 303
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80014-1426
Practice Address - Country:US
Practice Address - Phone:303-337-7994
Practice Address - Fax:303-337-0719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1053951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty