MEDICARE: DR. LESLIE A WAHL D.D.S.

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	122300000X	Dentist	DS027386L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	781460	OTHER	PA	UNITED CONCORDIA COMPANIE

General Provider Information

NPI Number	:	1790898658
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE A WAHL D.D.S.

Provider Business Mailing Address
First Line	:	357 HAZEL DR
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15228-2132
Country	:	US
Telephone Number	:	412-561-1299
Fax Number	:

Provider Business Practice Location Address
First Line	:	4411 STILLEY RD
Second Line	:	SUITE 203
City	:	PITTSBURGH
State	:	PA
Zip	:	15227-1369
Country	:	US
Telephone Number	:	412-884-8807
Fax Number	:	412-884-9134

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/08/2007

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