Provider Demographics
NPI:1801225578
Name:DOUGLAS A. WHEELOCK, DDS, PC
Entity Type:Organization
Organization Name:DOUGLAS A. WHEELOCK, DDS, PC
Other - Org Name:WHEELOCK AND BURSICK DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KELLI
Authorized Official - Middle Name:B
Authorized Official - Last Name:MCWILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:712-274-2038
Mailing Address - Street 1:4100 MORNINGSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SIOUX CITY
Mailing Address - State:IA
Mailing Address - Zip Code:51106-2974
Mailing Address - Country:US
Mailing Address - Phone:712-274-2038
Mailing Address - Fax:712-274-0648
Practice Address - Street 1:4100 MORNINGSIDE AVE
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51106-2974
Practice Address - Country:US
Practice Address - Phone:712-274-2038
Practice Address - Fax:712-274-0648
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA061541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty