Provider Demographics
NPI:1316599558
Name:WHEELER, KELSI ANNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:KELSI
Middle Name:ANNE
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 1:1420 LINCOLN WAY STE 200
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-2360
Mailing Address - Country:US
Mailing Address - Phone:208-664-8283
Mailing Address - Fax:208-667-0794
Practice Address - Street 1:1420 LINCOLN WAY STE 200
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2360
Practice Address - Country:US
Practice Address - Phone:208-664-8283
Practice Address - Fax:208-667-0794
Is Sole Proprietor?:No
Enumeration Date:2019-07-09
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-50711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice