Provider Demographics
NPI:1699987750
Name:EUBANK, MICHELE WHEELER (DMD)
Entity type:Individual
Prefix:DR
First Name:MICHELE
Middle Name:WHEELER
Last Name:EUBANK
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 1:107 SHERWOOD DR
Mailing Address - Street 2:P.O. BOX 1926
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-4717
Mailing Address - Country:US
Mailing Address - Phone:706-754-7433
Mailing Address - Fax:706-754-1963
Practice Address - Street 1:107 SHERWOOD DR
Practice Address - Street 2:
Practice Address - City:CLARKESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30523-4717
Practice Address - Country:US
Practice Address - Phone:706-754-7433
Practice Address - Fax:706-754-1963
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA011689122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist