=====================================================
General NPI Number Information
=====================================================
NPI Number | 1871857813
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | REBECCA T. WHEELER, DMD
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/25/2012
-----------------------------------------------------
Last Update Date | 06/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 106 FAIRFIELD DR
-----------------------------------------------------
City | NICHOLASVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40356-8842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-885-0086
-----------------------------------------------------
Fax | 859-885-1290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 106 FAIRFIELD DR
-----------------------------------------------------
City | NICHOLASVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40356-8842
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-885-0086
-----------------------------------------------------
Fax | 859-885-1290
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/DENTIST
-----------------------------------------------------
Name | DR. REBECCA T WHEELER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 859-885-0086
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | 6755
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------