Provider Demographics
NPI:1659668499
Name:WHEELER, JULIA NICOLE (DMD)
Entity Type:Individual
Prefix:DR
First Name:JULIA
Middle Name:NICOLE
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 1:5172 WRIGHTSBORO RD
Mailing Address - Street 2:
Mailing Address - City:GROVETOWN
Mailing Address - State:GA
Mailing Address - Zip Code:30813-2802
Mailing Address - Country:US
Mailing Address - Phone:706-860-1352
Mailing Address - Fax:706-860-7221
Practice Address - Street 1:5172 WRIGHTSBORO RD
Practice Address - Street 2:
Practice Address - City:GROVETOWN
Practice Address - State:GA
Practice Address - Zip Code:30813-2802
Practice Address - Country:US
Practice Address - Phone:706-860-1352
Practice Address - Fax:706-860-7221
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014255122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist