Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | DDS-09045 | IA |
Y | 1223P0700X | Prosthodontist | 15922 | MD |
NPI | 1083068027 |
---|---|
Provider Name | William Maxwell Wahle |
First Address | Towson, MD 21204-2341 |
Second Address | Towson, MD 21204-2341 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/04/2016 |
Last Update Date | 11/03/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
15922 | MARYLAND DENTAL BOARD (01) | MD |