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General NPI Number Information
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NPI Number | 1861081879
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Entity Type | Organization
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Legal Business Name | TYLER S WHEELER DMD PC
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Dates
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Enumeration Date | 01/13/2021
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Last Update Date | 01/13/2021
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Provider Practice Location Address
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Address Line | 14120 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-4527
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Country | US
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Telephone | 228-832-1988
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Fax | 228-832-0068
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Provider Business Mailing Address
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Address Line | 14120 DEDEAUX RD
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City | GULFPORT
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State | MS
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Zip | 39503-4527
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Country | US
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Telephone | 228-832-1988
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Fax | 228-832-0068
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. TYLER SAMUEL WHEELER
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Credential | DMD
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Telephone | 228-697-2941
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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