Provider Demographics
NPI:1639748056
Name:JENNIFER L. WAHLEN, DMD PC
Entity Type:Organization
Organization Name:JENNIFER L. WAHLEN, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:L
Authorized Official - Last Name:WAHLEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:801-721-7151
Mailing Address - Street 1:2480 S HIGHWAY 89 STE A
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-6727
Mailing Address - Country:US
Mailing Address - Phone:435-723-9443
Mailing Address - Fax:435-723-9445
Practice Address - Street 1:2480 S HIGHWAY 89 STE A
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-6727
Practice Address - Country:US
Practice Address - Phone:435-723-9443
Practice Address - Fax:435-723-9445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-21
Last Update Date:2021-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty