Provider Demographics
NPI:1518018258
Name:WHEELER, THOMAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 NEW ALBANY PLZ
Mailing Address - Street 2:
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4654
Mailing Address - Country:US
Mailing Address - Phone:812-945-0191
Mailing Address - Fax:
Practice Address - Street 1:360 NEW ALBANY PLZ
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4654
Practice Address - Country:US
Practice Address - Phone:812-945-0191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2011-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8107122300000X
IN12011718A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist