Roger Wahlman, D.D.S.
Individual provider Active NPI General Practice Dentistry · Angels Camp, CA
NPI 1790762375 · NPPES record last updated Jul 13, 2026
Key facts
- NPI
- 1790762375
- Entity type
- Individual (NPI type 1)
- Primary specialty
- General Practice Dentistry 1223G0001X
- License
- 23394 (CA)
- Practice address
- 571 Stanislaus Ave.
Angels Camp, CA 95221 - Phone
- (209) 736-4641
- NPI assigned
- Dec 27, 2005
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 23394 | CA | MD | General Practice Dentistry |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 23394 | CA | Yes |
Addresses
Primary practice location
571 Stanislaus Ave.
Angels Camp, CA 95221
Mailing address
PO Box 820
Altaville, CA 95221-0820
Phone (209) 736-4641
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All providers in Angels Camp, CA · General Practice Dentistry in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2026. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.