Provider Demographics
NPI:1265535637
Name:WAHL, MICHAEL J (DDS)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:WAHL
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 1:1601 CONCORD PIKE
Mailing Address - Street 2:SU 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:SU 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
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DE9401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice