Healthcare Provider Details

I. General information

NPI: 1972294676
Provider Name (Legal Business Name): THOMAS DENTAL GROUP OF ENCINO, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2023
Last Update Date: 10/29/2025
Certification Date: 10/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16260 VENTURA BLVD STE 800
ENCINO CA
91436-4606
US

IV. Provider business mailing address

1220 CARAWAY CT STE 1050
UPPER MARLBORO MD
20774-5338
US

V. Phone/Fax

Practice location:
  • Phone: 301-494-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFFERY WHEELER
Title or Position: CEO
Credential:
Phone: 818-814-9800