Provider Demographics
NPI:1720168685
Name:WHEELER, TERRI LYNN (DDS)
Entity Type:Individual
Prefix:
First Name:TERRI
Middle Name:LYNN
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:770 N. COTNER BLVD.
Mailing Address - Street 2:SUITE 202
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68505
Mailing Address - Country:US
Mailing Address - Phone:402-434-2360
Mailing Address - Fax:
Practice Address - Street 1:770 N COTNER BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68505-2310
Practice Address - Country:US
Practice Address - Phone:402-434-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE50611223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47-0757188-00Medicaid