Healthcare Provider Details

I. General information

NPI: 1720144439
Provider Name (Legal Business Name): LEE R. WHEELER DDS PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2006
Last Update Date: 07/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5050 NE HOYT ST #528
PORTLAND OR
97213-2991
US

IV. Provider business mailing address

5050 NE HOYT ST SUITE 528
PORTLAND OR
97213-2991
US

V. Phone/Fax

Practice location:
  • Phone: 503-233-7176
  • Fax:
Mailing address:
  • Phone: 503-233-7176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: LEE R WHEELER
Title or Position: DENTIST
Credential: DDS PC
Phone: 503-233-7176