Provider Demographics
NPI:1194801829
Name:WHEELER, GREGORY A (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:A
Last Name:WHEELER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:852 W LIBERTY STREET
Mailing Address - Street 2:SUMTER FAMILY DENTAL CENTER PA
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150
Mailing Address - Country:US
Mailing Address - Phone:803-773-3328
Mailing Address - Fax:803-773-9601
Practice Address - Street 1:SUMTER FAMILY DENTAL CENTER PA
Practice Address - Street 2:852 W LIBERTY STREET
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-773-3328
Practice Address - Fax:803-773-9601
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC30-032991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice