Provider Demographics
NPI:1326039082
Name:WHEELER, LARRY F (DDS)
Entity Type:Individual
Prefix:DR
First Name:LARRY
Middle Name:F
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5639 E 5TH ST
Mailing Address - Street 2:SUITE E&F
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-2443
Mailing Address - Country:US
Mailing Address - Phone:520-745-0030
Mailing Address - Fax:520-747-2054
Practice Address - Street 1:5639 E 5TH ST
Practice Address - Street 2:SUITE E&F
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85711-2443
Practice Address - Country:US
Practice Address - Phone:520-745-0030
Practice Address - Fax:520-747-2054
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice