Provider Demographics
NPI:1306391941
Name:TARA J WHEELER DMD OR STEVEN M CRAINE DMD, PC
Entity Type:Organization
Organization Name:TARA J WHEELER DMD OR STEVEN M CRAINE DMD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TARA
Authorized Official - Middle Name:J
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:251-964-2671
Mailing Address - Street 1:2122 S HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:LOXLEY
Mailing Address - State:AL
Mailing Address - Zip Code:36551-4648
Mailing Address - Country:US
Mailing Address - Phone:251-964-2671
Mailing Address - Fax:251-964-2673
Practice Address - Street 1:2122 S HICKORY ST
Practice Address - Street 2:
Practice Address - City:LOXLEY
Practice Address - State:AL
Practice Address - Zip Code:36551-4648
Practice Address - Country:US
Practice Address - Phone:251-964-2671
Practice Address - Fax:251-964-2673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty