Healthcare Provider Details

I. General information

NPI: 1720972664
Provider Name (Legal Business Name): WAHLSTROM SURGICAL ARTS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2025
Last Update Date: 09/04/2025
Certification Date: 09/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10603 N HAYDEN RD STE H112
SCOTTSDALE AZ
85260-5679
US

IV. Provider business mailing address

10603 N HAYDEN RD STE H112
SCOTTSDALE AZ
85260-5679
US

V. Phone/Fax

Practice location:
  • Phone: 480-922-9933
  • Fax:
Mailing address:
  • Phone: 480-922-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204E00000X
TaxonomyOral & Maxillofacial Surgery (D.M.D.)
License Number
License Number State

VIII. Authorized Official

Name: DEVIN WAHLSTROM
Title or Position: OWNER/ORAL SURGEON
Credential: DMD
Phone: 503-752-2909