Provider Demographics
NPI:1194841239
Name:WHEELER, LEA DAVIS (DMD)
Entity type:Individual
Prefix:DR
First Name:LEA
Middle Name:DAVIS
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4406 S FLORIDA AVE
Mailing Address - Street 2:SUITE 29
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2172
Mailing Address - Country:US
Mailing Address - Phone:863-701-0234
Mailing Address - Fax:863-701-7642
Practice Address - Street 1:4406 S FLORIDA AVE
Practice Address - Street 2:SUITE 29
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2172
Practice Address - Country:US
Practice Address - Phone:863-701-0234
Practice Address - Fax:863-701-7642
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 145581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice