Provider Demographics
NPI:1609402411
Name:WAHLIN, RYAN (DDS)
Entity type:Individual
Prefix:DR
First Name:RYAN
Middle Name:
Last Name:WAHLIN
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 1:307 WEST LOSEY STREET
Mailing Address - Street 2:BUILDING #1535
Mailing Address - City:APO
Mailing Address - State:AA
Mailing Address - Zip Code:62225
Mailing Address - Country:US
Mailing Address - Phone:618-256-6667
Mailing Address - Fax:
Practice Address - Street 1:48TH MEDICAL GROUP
Practice Address - Street 2:RAF LAKENHEATH, UNIT 5115
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09461-5115
Practice Address - Country:US
Practice Address - Phone:314-226-8010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-13
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE61085933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist