Provider Demographics
NPI:1205323029
Name:WLA ASSOCIATES
Entity type:Organization
Organization Name:WLA ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:COURTNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:STUHLMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-272-8222
Mailing Address - Street 1:1681 MERIDEN RD
Mailing Address - Street 2:
Mailing Address - City:WOLCOTT
Mailing Address - State:CT
Mailing Address - Zip Code:06716-3322
Mailing Address - Country:US
Mailing Address - Phone:203-633-7178
Mailing Address - Fax:203-528-4965
Practice Address - Street 1:1681 MERIDEN RD
Practice Address - Street 2:
Practice Address - City:WOLCOTT
Practice Address - State:CT
Practice Address - Zip Code:06716-3322
Practice Address - Country:US
Practice Address - Phone:203-633-7178
Practice Address - Fax:203-528-4965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:WLA ASSOCIATES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-04-17
Last Update Date:2018-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6009122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty