Individual
BRENT WHEELER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
2275 S EAGLE RD STE 150, MERIDIAN, ID 83642-5075
(208) 215-7449
Mailing address
6160 S RED FOX CIR, TAYLORSVILLE, UT 84129-3718
(760) 608-3993
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
12795233-9922
UT
1223G0001X
General Practice Dentistry
Primary
D-5400
ID
Other
Enumeration date
04/14/2022
Last updated
04/25/2022
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