Provider Demographics
NPI:1497877815
Name:BONNIE DANIELS WHEATLEY, D.M.D., P.S.C.
Entity Type:Organization
Organization Name:BONNIE DANIELS WHEATLEY, D.M.D., P.S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BONNIE
Authorized Official - Middle Name:DANIELS
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:1859-745-1250
Mailing Address - Street 1:100 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:WINCHESTER
Mailing Address - State:KY
Mailing Address - Zip Code:40391-2412
Mailing Address - Country:US
Mailing Address - Phone:859-745-1250
Mailing Address - Fax:859-744-1201
Practice Address - Street 1:100 HUBBARD RD
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:KY
Practice Address - Zip Code:40391-2412
Practice Address - Country:US
Practice Address - Phone:859-745-1250
Practice Address - Fax:859-744-1201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2009-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Single Specialty