MEDICARE: KARL F. WEHRLE DDS INC

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	24887	CA

General Provider Information

NPI Number	:	1811183478
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KARL F. WEHRLE DDS INC

Provider Business Mailing Address
First Line	:	8425 GRANT ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5303
Country	:	US
Telephone Number	:	619-464-3631
Fax Number	:	619-464-3724

Provider Business Practice Location Address
First Line	:	8425 GRANT ST
Second Line	:
City	:	LA MESA
State	:	CA
Zip	:	91941-5303
Country	:	US
Telephone Number	:	619-464-3631
Fax Number	:	619-464-3724

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	CORINNE KAY PHILLIPS
Credential	:
Telephone Number	:	619-464-3631

Provider Enumeration Date	:	09/18/2007
Last Update Date	:	11/26/2012

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