Healthcare Provider Details

I. General information

NPI: 1568545671
Provider Name (Legal Business Name): REBECCA T WHEELER DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 01/20/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 FAIRFIELD DRIVE
NICHOLASVILLE KY
40356
US

IV. Provider business mailing address

106 FAIRFIELD DRIVE
NICHOLASVILLE KY
40356
US

V. Phone/Fax

Practice location:
  • Phone: 859-885-0086
  • Fax: 859-885-1290
Mailing address:
  • Phone: 859-885-0086
  • Fax: 859-885-1290

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberKY 6755 KYSL 674
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberKY 6755 KYSL 674
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: