MEDICARE: MICHAEL ERNEST WAHL DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	105967	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1770584716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL ERNEST WAHL DDS

Provider Business Mailing Address
First Line	:	1104 W COLORADO AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	719-633-8766
Fax Number	:	719-635-5259

Provider Business Practice Location Address
First Line	:	1104 W COLORADO AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80904
Country	:	US
Telephone Number	:	719-633-8766
Fax Number	:	719-635-5259

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/02/2005
Last Update Date	:	03/07/2023

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