Provider Demographics
NPI:1790898658
Name:WAHL, LESLIE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:A
Last Name:WAHL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:357 HAZEL DR
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15228-2132
Mailing Address - Country:US
Mailing Address - Phone:412-561-1299
Mailing Address - Fax:
Practice Address - Street 1:4411 STILLEY RD
Practice Address - Street 2:SUITE 203
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15227-1369
Practice Address - Country:US
Practice Address - Phone:412-884-8807
Practice Address - Fax:412-884-9134
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS027386L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA781460OtherUNITED CONCORDIA COMPANIE