Provider Demographics
NPI:1205908431
Name:WAHL, JEAN ANNE GARRIPOLI (DMD)
Entity type:Individual
Prefix:
First Name:JEAN
Middle Name:ANNE GARRIPOLI
Last Name:WAHL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 YORK RD
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19803
Mailing Address - Country:US
Mailing Address - Phone:302-654-7696
Mailing Address - Fax:
Practice Address - Street 1:1601 CONCORD PIKE
Practice Address - Street 2:STE #99 WAHL FAMILY DENTISTRY
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
Is Sole Proprietor?:No
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEG10001128122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist