Provider Demographics
NPI:1174065189
Name:WAHL, CAROLYNN (RDH)
Entity type:Individual
Prefix:
First Name:CAROLYNN
Middle Name:
Last Name:WAHL
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:917 ASH ST APT 917
Mailing Address - Street 2:
Mailing Address - City:MOOSIC
Mailing Address - State:PA
Mailing Address - Zip Code:18507-1220
Mailing Address - Country:US
Mailing Address - Phone:570-510-7888
Mailing Address - Fax:
Practice Address - Street 1:917 ASH ST APT 917
Practice Address - Street 2:
Practice Address - City:MOOSIC
Practice Address - State:PA
Practice Address - Zip Code:18507-1220
Practice Address - Country:US
Practice Address - Phone:570-510-7888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-08
Last Update Date:2024-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH006201L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist