Provider Demographics
NPI:1164027728
Name:WHEELER, JILL MARIE (RDH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:MARIE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:767 S ORANGE BLOSSOM TRL
Mailing Address - Street 2:
Mailing Address - City:APOPKA
Mailing Address - State:FL
Mailing Address - Zip Code:32703-3708
Mailing Address - Country:US
Mailing Address - Phone:407-889-2555
Mailing Address - Fax:407-889-4421
Practice Address - Street 1:767 S ORANGE BLOSSOM TRL
Practice Address - Street 2:
Practice Address - City:APOPKA
Practice Address - State:FL
Practice Address - Zip Code:32703-3708
Practice Address - Country:US
Practice Address - Phone:407-889-2555
Practice Address - Fax:407-889-4421
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-02
Last Update Date:2024-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL15227124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist