Provider Demographics
NPI:1114226636
Name:WHEELER, JUDITH CAROL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:CAROL
Last Name:WHEELER
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 1:915 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:OH
Mailing Address - Zip Code:44240-2217
Mailing Address - Country:US
Mailing Address - Phone:239-298-2906
Mailing Address - Fax:
Practice Address - Street 1:915 W MAIN ST
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:OH
Practice Address - Zip Code:44240-2217
Practice Address - Country:US
Practice Address - Phone:239-298-2906
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.015942122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist