Healthcare Provider Details

I. General information

NPI: 1184663262
Provider Name (Legal Business Name): ROBERT T. WHEELER JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2006
Last Update Date: 11/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24400 MUIRLANDS BLVD SUITE C
LAKE FOREST CA
92630-3946
US

IV. Provider business mailing address

24400 MUIRLANDS BLVD SUITE C
LAKE FOREST CA
92630-3946
US

V. Phone/Fax

Practice location:
  • Phone: 949-859-3822
  • Fax: 949-859-3824
Mailing address:
  • Phone: 949-859-3822
  • Fax: 949-859-3824

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberD27853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: