Provider Demographics
NPI:1649258666
Name:WHEELER, MARK ALLEN (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:ALLEN
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 1:2461 RANCH RESERVE RDG
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CO
Mailing Address - Zip Code:80234-2693
Mailing Address - Country:US
Mailing Address - Phone:303-870-9151
Mailing Address - Fax:
Practice Address - Street 1:899 HIGHWAY 287
Practice Address - Street 2:SUITE 100
Practice Address - City:BROOMFIELD
Practice Address - State:CO
Practice Address - Zip Code:80020-7000
Practice Address - Country:US
Practice Address - Phone:303-469-6375
Practice Address - Fax:303-465-0656
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO61191223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics