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General NPI Number Information
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NPI Number | 1134657711
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Entity Type | Individual
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Provider Name | ANDREW E. WHEATLEY
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Gender | Male
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Dates
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Enumeration Date | 05/26/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 2328 S 4TH ST
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City | CHICKASHA
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State | OK
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Zip | 73018-6804
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Country | US
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Telephone | 405-222-2266
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Fax | 405-320-5897
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Provider Business Mailing Address
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Address Line | 2328 S 4TH ST
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City | CHICKASHA
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State | OK
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Zip | 73018-6804
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Country | US
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Telephone | 405-222-2266
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Fax | 405-320-5897
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 6919
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License Number State | OK
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