Provider Demographics
NPI:1760437578
Name:WHEELER, CHARLES EDGAR (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:EDGAR
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6810 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:REYNOLDSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43068-2268
Mailing Address - Country:US
Mailing Address - Phone:614-866-6338
Mailing Address - Fax:614-575-9514
Practice Address - Street 1:6810 E MAIN ST
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-2268
Practice Address - Country:US
Practice Address - Phone:614-866-6338
Practice Address - Fax:614-575-9514
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH300150021223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH30015002OtherDENTAL LICENSE