Healthcare Provider Details

I. General information

NPI: 1821159898
Provider Name (Legal Business Name): WAHL FAMILY DENTISTRY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CONCORD PIKE SUITE 99
WILMINGTON DE
19803
US

IV. Provider business mailing address

1601 CONCORD PIKE SUITE 99
WILMINGTON DE
19803
US

V. Phone/Fax

Practice location:
  • Phone: 302-655-1228
  • Fax: 302-655-8108
Mailing address:
  • Phone: 302-655-1228
  • Fax: 302-655-8108

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL J WAHL
Title or Position: PRESIDENT
Credential: DDS
Phone: 302-655-1228