Provider Demographics
NPI:1568545671
Name:WHEELER, REBECCA T (DMD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:T
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 FAIRFIELD DRIVE
Mailing Address - Street 2:
Mailing Address - City:NICHOLASVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40356
Mailing Address - Country:US
Mailing Address - Phone:859-885-0086
Mailing Address - Fax:859-885-1290
Practice Address - Street 1:106 FAIRFIELD DRIVE
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356
Practice Address - Country:US
Practice Address - Phone:859-885-0086
Practice Address - Fax:859-885-1290
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY 6755 KYSL 6741223P0221X
KYKY 6755 KYSL 674122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY60000601Medicaid
KY7100101220Medicaid