Provider Demographics
NPI:1477268324
Name:WHEELER DENTISTRY
Entity Type:Organization
Organization Name:WHEELER DENTISTRY
Other - Org Name:LCF DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING LEAD
Authorized Official - Prefix:
Authorized Official - First Name:JENNY
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA-ROCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-869-3789
Mailing Address - Street 1:1346 FOOTHILL BLVD
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2122
Mailing Address - Country:US
Mailing Address - Phone:818-790-1710
Mailing Address - Fax:818-790-1561
Practice Address - Street 1:1346 FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:LA CANADA
Practice Address - State:CA
Practice Address - Zip Code:91011-2122
Practice Address - Country:US
Practice Address - Phone:818-790-1710
Practice Address - Fax:818-790-1561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-16
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty