Organization
BRAD A. WAHLSTROM, D.D.S., P.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. BRAD A. WAHLSTROM D.D.S. (PRESIDENT)
(801) 566-3003
Entity
Organization
Contact information
Practice address
7089 S REDWOOD RD, WEST JORDAN, UT 84084-3420
(801) 566-3003
(801) 568-1710
Mailing address
7089 S REDWOOD RD, WEST JORDAN, UT 84084-3420
(801) 566-3003
(801) 568-1710
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
4791609-9923
UT
Other
Enumeration date
08/19/2010
Last updated
08/19/2010
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