Provider Demographics
NPI:1427561042
Name:MICHAEL WHEATLEY DDS OF SOUTH DAKOTA PC
Entity Type:Organization
Organization Name:MICHAEL WHEATLEY DDS OF SOUTH DAKOTA PC
Other - Org Name:WHEATLEY ENDODONTICS PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:406-217-5183
Mailing Address - Street 1:2928 HAMILTON BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51104-2424
Mailing Address - Country:US
Mailing Address - Phone:712-258-3636
Mailing Address - Fax:712-255-4163
Practice Address - Street 1:811 BELFAST ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3324
Practice Address - Country:US
Practice Address - Phone:712-258-3636
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty