Provider Demographics
NPI:1508084245
Name:SCHEELS, JOHN L (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:L
Last Name:SCHEELS
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 1:6803 W WELLS ST
Mailing Address - Street 2:
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53213-3811
Mailing Address - Country:US
Mailing Address - Phone:414-259-1155
Mailing Address - Fax:414-259-0994
Practice Address - Street 1:6803 W WELLS ST
Practice Address - Street 2:
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53213-3811
Practice Address - Country:US
Practice Address - Phone:414-259-1155
Practice Address - Fax:414-259-0994
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI500-1494 WI1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice