Provider Demographics
NPI:1083814198
Name:WHEAT, TILLMAN LARRY III (DDS)
Entity Type:Individual
Prefix:DR
First Name:TILLMAN
Middle Name:LARRY
Last Name:WHEAT
Suffix:III
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11902 JONES RD STE F
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-5234
Mailing Address - Country:US
Mailing Address - Phone:281-890-0207
Mailing Address - Fax:281-890-0349
Practice Address - Street 1:11902 JONES RD STE F
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-5234
Practice Address - Country:US
Practice Address - Phone:281-890-0207
Practice Address - Fax:281-890-0349
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116251223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice