Provider Demographics
NPI:1871951517
Name:TIMOTHY J WAHLE DDS INC
Entity type:Organization
Organization Name:TIMOTHY J WAHLE DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:J
Authorized Official - Last Name:WAHLE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:707-224-3148
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-09
Last Update Date:2016-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA447991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty