Provider Demographics
NPI:1962923268
Name:WHEELER, BENJAMIN LANIER (DMD)
Entity type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:LANIER
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 1:1845 PEABODY AVE APT C
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38104-4023
Mailing Address - Country:US
Mailing Address - Phone:912-286-3909
Mailing Address - Fax:
Practice Address - Street 1:1240 HIGHWAY 54 W STE 315
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-4572
Practice Address - Country:US
Practice Address - Phone:770-478-6878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2019-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0158271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics