Provider Demographics
NPI:1730495177
Name:WHEELER, JENNIFER LYNN (DMD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LYNN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:LYNN
Other - Last Name:SPROEHNLE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:1548 WOODLAKE DR
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-5712
Mailing Address - Country:US
Mailing Address - Phone:314-576-3737
Mailing Address - Fax:314-576-3740
Practice Address - Street 1:1548 WOODLAKE DR
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-5712
Practice Address - Country:US
Practice Address - Phone:314-576-3737
Practice Address - Fax:314-576-3737
Is Sole Proprietor?:No
Enumeration Date:2010-08-24
Last Update Date:2016-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009032630122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist