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General NPI Number Information
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NPI Number | 1952044208
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Entity Type | Individual
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Provider Name | BRENT WHEELER DMD
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Gender | Male
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Dates
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Enumeration Date | 04/14/2022
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Last Update Date | 04/25/2022
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Provider Practice Location Address
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Address Line | 2275 S EAGLE RD STE 150
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City | MERIDIAN
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State | ID
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Zip | 83642-5075
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Country | US
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Telephone | 208-215-7449
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Fax |
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Provider Business Mailing Address
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Address Line | 6160 S RED FOX CIR
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City | TAYLORSVILLE
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State | UT
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Zip | 84129-3718
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Country | US
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Telephone | 760-608-3993
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Fax |
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 12795233-9922
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License Number State | UT
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D-5400
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License Number State | ID
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