MEDICARE: CAROLYN WAHBY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	61905	CA

General Provider Information

NPI Number	:	1194060046
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLYN WAHBY

Provider Business Mailing Address
First Line	:	13905 VISIONS DR
Second Line	:
City	:	LA MIRADA
State	:	CA
Zip	:	90638-6563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5464 SOUTH ST
Second Line	:
City	:	LAKEWOOD
State	:	CA
Zip	:	90712-1354
Country	:	US
Telephone Number	:	714-883-0348
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2012
Last Update Date	:	02/13/2013

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Directions to “ CAROLYN WAHBY ” Practice Location

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