Healthcare Provider Details

I. General information

NPI: 1861432411
Provider Name (Legal Business Name): DOUGLAS CRAIG WHEELER D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SW 8TH AVE
MILTON FREEWATER OR
97862-1595
US

IV. Provider business mailing address

1 SW 8TH AVE
MILTON FREEWATER OR
97862-1595
US

V. Phone/Fax

Practice location:
  • Phone: 541-938-7752
  • Fax: 541-938-7191
Mailing address:
  • Phone: 541-938-7752
  • Fax: 541-938-7191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number5410
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: