Provider Demographics
NPI:1962917658
Name:WHEELER FAMILY DENTISTRY PLLC
Entity type:Organization
Organization Name:WHEELER FAMILY DENTISTRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:KALLEN
Authorized Official - Middle Name:CLINTON
Authorized Official - Last Name:WHEELER
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:208-757-8784
Mailing Address - Street 1:10025 LAKE JUNE RD
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75217-3041
Mailing Address - Country:US
Mailing Address - Phone:972-362-2237
Mailing Address - Fax:
Practice Address - Street 1:14425 W MCDOWELL RD STE F106
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85395-2516
Practice Address - Country:US
Practice Address - Phone:623-925-8208
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-04
Last Update Date:2020-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX319871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty