Provider Demographics
NPI:1265569867
Name:WHEELER, EVAN L (DDS)
Entity type:Individual
Prefix:DR
First Name:EVAN
Middle Name:L
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 1:3691 CAMERON STREET
Mailing Address - Street 2:SUITE 101
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99709
Mailing Address - Country:US
Mailing Address - Phone:907-479-8123
Mailing Address - Fax:907-479-0685
Practice Address - Street 1:3691 CAMERON ST
Practice Address - Street 2:SUITE 101
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-3843
Practice Address - Country:US
Practice Address - Phone:907-479-8123
Practice Address - Fax:907-479-0685
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice