1033227566 NPI number — SAMUEL FAIR WHEELER DMD

Table of content: SAMUEL FAIR WHEELER DMD (NPI 1033227566)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033227566 NPI number — SAMUEL FAIR WHEELER DMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WHEELER
Provider First Name:
SAMUEL
Provider Middle Name:
FAIR
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DMD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033227566
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 567
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALUDA
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
864-445-8124
Provider Business Mailing Address Fax Number:
864-445-9504

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 N BANKS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALUDA
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-445-8124
Provider Business Practice Location Address Fax Number:
864-445-9504
Provider Enumeration Date:
08/25/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  2067 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)