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General NPI Number Information
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NPI Number | 1477848596
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Entity Type | Organization
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Legal Business Name | TARA J WHEELER DMD LLC
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Dates
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Enumeration Date | 06/16/2011
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Last Update Date | 06/16/2011
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Provider Practice Location Address
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Address Line | 2127 N HICKORY ST SUITE D
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City | LOXLEY
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State | AL
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Zip | 36551-2411
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Country | US
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Telephone | 251-964-2671
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Fax | 251-964-2673
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Provider Business Mailing Address
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Address Line | 520 2ND AVE
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City | PLEASANT GROVE
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State | AL
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Zip | 35127-1757
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER, DENTIST
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Name | TARA J WHEELER
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Credential | D.M.D.
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Telephone | 205-616-0419
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 5751
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License Number State | AL
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