Provider Demographics
NPI:1801102124
Name:WHEATLAND DENTAL CARE LTD
Entity type:Organization
Organization Name:WHEATLAND DENTAL CARE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARFAEI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-904-4444
Mailing Address - Street 1:5060 ACE LANE
Mailing Address - Street 2:STE 100
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564
Mailing Address - Country:US
Mailing Address - Phone:630-904-4444
Mailing Address - Fax:630-904-3770
Practice Address - Street 1:5060 ACE LANE
Practice Address - Street 2:STE 100
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564
Practice Address - Country:US
Practice Address - Phone:630-904-4444
Practice Address - Fax:630-904-3770
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-24
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190230951223G0001X
IL0190270281223G0001X
IL0190203971223G0001X
IL0190253091223G0001X
IL0190187241223G0001X
IL0190267611223G0001X
IL0210010931223P0300X
IL0210022841223P0300X
IL0210011651223S0112X
IL0210014751223X0400X
IL0190231741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Multi-Specialty
No1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial OrthopedicsGroup - Multi-Specialty