Provider Demographics
NPI:1033227566
Name:WHEELER, SAMUEL FAIR (DMD)
Entity Type:Individual
Prefix:
First Name:SAMUEL
Middle Name:FAIR
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 567
Mailing Address - Street 2:
Mailing Address - City:SALUDA
Mailing Address - State:SC
Mailing Address - Zip Code:29138
Mailing Address - Country:US
Mailing Address - Phone:864-445-8124
Mailing Address - Fax:864-445-9504
Practice Address - Street 1:201 N BANKS ST
Practice Address - Street 2:
Practice Address - City:SALUDA
Practice Address - State:SC
Practice Address - Zip Code:29138
Practice Address - Country:US
Practice Address - Phone:864-445-8124
Practice Address - Fax:864-445-9504
Is Sole Proprietor?:No
Enumeration Date:2006-08-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2067122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCZ20674Medicare ID - Type Unspecified