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General NPI Number Information
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NPI Number | 1720972664
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Entity Type | Organization
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Legal Business Name | WAHLSTROM SURGICAL ARTS
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Dates
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Enumeration Date | 06/05/2025
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Last Update Date | 09/04/2025
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Provider Practice Location Address
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Address Line | 10603 N HAYDEN RD STE H112
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5679
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Country | US
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Telephone | 480-922-9933
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Fax |
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Provider Business Mailing Address
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Address Line | 10603 N HAYDEN RD STE H112
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City | SCOTTSDALE
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State | AZ
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Zip | 85260-5679
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Country | US
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Telephone | 480-922-9933
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Fax |
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Authorized Official
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Title or Position | OWNER/ORAL SURGEON
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Name | DEVIN WAHLSTROM
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Credential | DMD
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Telephone | 503-752-2909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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