Provider Demographics
NPI:1366092033
Name:WHEELER, EMILY (EPDH)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:WHEELER
Suffix:
Gender:F
Credentials:EPDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91160 N EMERALD ST
Mailing Address - Street 2:
Mailing Address - City:COBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97408-9271
Mailing Address - Country:US
Mailing Address - Phone:541-579-4833
Mailing Address - Fax:
Practice Address - Street 1:1282 GOODPASTURE ISLAND RD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-1774
Practice Address - Country:US
Practice Address - Phone:541-579-4833
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORH4915124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist