Provider Demographics
NPI:1538456678
Name:EVAN L. WHEELER DDS,PC
Entity Type:Organization
Organization Name:EVAN L. WHEELER DDS,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SHERI
Authorized Official - Middle Name:R
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-479-8123
Mailing Address - Street 1:3691 CAMERON ST
Mailing Address - Street 2:STE 101
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709-3843
Mailing Address - Country:US
Mailing Address - Phone:907-479-8123
Mailing Address - Fax:907-479-0685
Practice Address - Street 1:3691 CAMERON ST
Practice Address - Street 2:STE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3843
Practice Address - Country:US
Practice Address - Phone:907-479-8123
Practice Address - Fax:907-479-0685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK8601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty