Provider Demographics
NPI:1720972664
Name:WAHLSTROM SURGICAL ARTS
Entity type:Organization
Organization Name:WAHLSTROM SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ORAL SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:
Authorized Official - Last Name:WAHLSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:503-752-2909
Mailing Address - Street 1:10603 N HAYDEN RD STE H112
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260-5679
Mailing Address - Country:US
Mailing Address - Phone:480-922-9933
Mailing Address - Fax:
Practice Address - Street 1:10603 N HAYDEN RD STE H112
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85260-5679
Practice Address - Country:US
Practice Address - Phone:480-922-9933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental