Provider Demographics
NPI:1114229721
Name:SHEELER DENTURE CLINIC
Entity Type:Organization
Organization Name:SHEELER DENTURE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTURIST
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:LD
Authorized Official - Phone:360-681-7999
Mailing Address - Street 1:680 W WASHINGTON ST
Mailing Address - Street 2:SUITE E-106
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3264
Mailing Address - Country:US
Mailing Address - Phone:360-681-7999
Mailing Address - Fax:360-582-9888
Practice Address - Street 1:680 W WASHINGTON ST
Practice Address - Street 2:SUITE E-106
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3264
Practice Address - Country:US
Practice Address - Phone:360-681-7999
Practice Address - Fax:360-582-9888
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-02
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADN00000232292200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes292200000XLaboratoriesDental Laboratory