Provider Demographics
NPI:1609295336
Name:WHEELER, BRYAN P (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRYAN
Middle Name:P
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
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Mailing Address - Street 1:11545A NUCKOLS ROAD
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23059-5666
Mailing Address - Country:US
Mailing Address - Phone:804-673-8061
Mailing Address - Fax:804-673-5644
Practice Address - Street 1:11319 POLO PL
Practice Address - Street 2:
Practice Address - City:MIDLOTHIAN
Practice Address - State:VA
Practice Address - Zip Code:23113-1434
Practice Address - Country:US
Practice Address - Phone:804-794-0794
Practice Address - Fax:804-379-2858
Is Sole Proprietor?:No
Enumeration Date:2014-04-09
Last Update Date:2024-01-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA04014160211223S0112X
VA0438000388204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery