Provider Demographics
NPI:1871606533
Name:WHEELER, DALE ALAN (D D S, MS)
Entity type:Individual
Prefix:DR
First Name:DALE
Middle Name:ALAN
Last Name:WHEELER
Suffix:
Gender:M
Credentials:D D S, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 GOOSE PT
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38571-3224
Mailing Address - Country:US
Mailing Address - Phone:931-456-4550
Mailing Address - Fax:931-456-8832
Practice Address - Street 1:80 PARKSIDE PLACE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38557-4085
Practice Address - Country:US
Practice Address - Phone:931-456-4569
Practice Address - Fax:931-456-8832
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70881223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics