Provider Demographics
NPI:1952575730
Name:WAHLE, TIMOTHY JOHN (DDS)
Entity Type:Individual
Prefix:DR
First Name:TIMOTHY
Middle Name:JOHN
Last Name:WAHLE
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 VILLA LN
Mailing Address - Street 2:#180
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-6405
Mailing Address - Country:US
Mailing Address - Phone:707-224-3148
Mailing Address - Fax:707-224-3140
Practice Address - Street 1:3434 VILLA LN
Practice Address - Street 2:#180
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6405
Practice Address - Country:US
Practice Address - Phone:707-224-3148
Practice Address - Fax:707-224-3140
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-14
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice