1548699341 NPI number — KYLE W. WHEELER, DDS, PC

Table of content: (NPI 1548699341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548699341 NPI number — KYLE W. WHEELER, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KYLE W. WHEELER, DDS, PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1548699341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1084 THOMAS JEFFERSON RD
Provider Second Line Business Mailing Address:
SUITE 5
Provider Business Mailing Address City Name:
FOREST
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24551-2298
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-385-6398
Provider Business Mailing Address Fax Number:
434-385-6847

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1084 THOMAS JEFFERSON RD
Provider Second Line Business Practice Location Address:
SUITE 5
Provider Business Practice Location Address City Name:
FOREST
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24551-2298
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-385-6398
Provider Business Practice Location Address Fax Number:
434-385-6847
Provider Enumeration Date:
11/02/2013

Additional Information

Authorized Official

Authorized Official Last Name:
WHEELER
Authorized Official First Name:
KYLE
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
434-385-6398

Provider Taxonomy Codes

  • Taxonomy code: 261QD0000X , with the licence number:  0401005293 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7813562 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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