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General NPI Number Information
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NPI Number | 1194060046
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Entity Type | Individual
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Provider Name | CAROLYN WAHBY
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Gender | Female
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Dates
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Enumeration Date | 12/04/2012
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Last Update Date | 02/13/2013
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Provider Practice Location Address
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Address Line | 5464 SOUTH ST
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City | LAKEWOOD
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State | CA
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Zip | 90712-1354
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Country | US
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Telephone | 714-883-0348
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Fax |
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Provider Business Mailing Address
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Address Line | 13905 VISIONS DR
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City | LA MIRADA
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State | CA
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Zip | 90638-6563
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 61905
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License Number State | CA
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