MEDICARE: DR. BENJAMIN LANIER WHEELER DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	015827	GA

General Provider Information

NPI Number	:	1962923268
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BENJAMIN LANIER WHEELER DMD

Provider Business Mailing Address
First Line	:	2321 POOLER PKWY STE 112
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4423
Country	:	US
Telephone Number	:	912-737-4114
Fax Number	:	912-737-4115

Provider Business Practice Location Address
First Line	:	2321 POOLER PKWY STE 112
Second Line	:
City	:	POOLER
State	:	GA
Zip	:	31322-4423
Country	:	US
Telephone Number	:	912-737-4114
Fax Number	:	912-737-4115

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/28/2017
Last Update Date	:	09/25/2025

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