Provider Demographics
NPI:1538389945
Name:GERMAN WAHLE, JOANN MARIE (DDS)
Entity type:Individual
Prefix:DR
First Name:JOANN
Middle Name:MARIE
Last Name:GERMAN WAHLE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 GRANDE AVE SE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52403-2816
Mailing Address - Country:US
Mailing Address - Phone:319-362-9686
Mailing Address - Fax:
Practice Address - Street 1:1855 1ST AVE SE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52402-5474
Practice Address - Country:US
Practice Address - Phone:319-362-9686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA07055122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist