Organization Name: | TARA J WHEELER DMD LLC |
NPI Number: | 1477848596 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | TARA J WHEELER (OWNER, DENTIST) |
Mailing Address: | 2127 N Hickory St Suite D Loxley |
State: | AL US |
Postal Code: | 365512411 |
Phone Number: | 2519642671 |
Fax Number: | 2519642673 |
NPI Enumeration Date: | 06/16/2011 |
NPI Last Update Date: | 06/16/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 5751 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | AL |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |