Healthcare Provider Details

I. General information

NPI: 1124589783
Provider Name (Legal Business Name): JOSHUA WOLHANDLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2019
Last Update Date: 08/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE WYOMING ST DEPT OF MEDICAL EDUCATION
DAYTON OH
45409
US

IV. Provider business mailing address

ONE WYOMING ST DEPT OF MEDICAL EDUCATION
DAYTON OH
45409
US

V. Phone/Fax

Practice location:
  • Phone: 937-208-2205
  • Fax:
Mailing address:
  • Phone: 937-208-2205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30.025812
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: