Provider Demographics
NPI:1972649226
Name:WHEELER, GORDON E (DMD)
Entity Type:Individual
Prefix:DR
First Name:GORDON
Middle Name:E
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:131 DEEP FOREST TRL
Mailing Address - Street 2:
Mailing Address - City:DAWSONVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30534-7753
Mailing Address - Country:US
Mailing Address - Phone:770-887-8283
Mailing Address - Fax:
Practice Address - Street 1:306 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CUMMING
Practice Address - State:GA
Practice Address - Zip Code:30040-2446
Practice Address - Country:US
Practice Address - Phone:770-887-8283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAGA89731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice