Provider Demographics
NPI:1821159898
Name:WAHL FAMILY DENTISTRY
Entity Type:Organization
Organization Name:WAHL FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAHL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:302-655-1228
Mailing Address - Street 1:1601 CONCORD PIKE
Mailing Address - Street 2:SUITE 99
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-655-1228
Mailing Address - Fax:302-655-8108
Practice Address - Street 1:1601 CONCORD PIKE
Practice Address - Street 2:SUITE 99
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19803
Practice Address - Country:US
Practice Address - Phone:302-655-1228
Practice Address - Fax:302-655-8108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty
Not Answered1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty