Provider Demographics
NPI:1538368774
Name:WHEELER, JAMIE RAE (DDS)
Entity type:Individual
Prefix:DR
First Name:JAMIE
Middle Name:RAE
Last Name:WHEELER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E GEORGIA ST
Mailing Address - Street 2:
Mailing Address - City:WOODRUFF
Mailing Address - State:SC
Mailing Address - Zip Code:29388-1953
Mailing Address - Country:US
Mailing Address - Phone:864-476-8315
Mailing Address - Fax:864-476-6150
Practice Address - Street 1:601 E GEORGIA ST
Practice Address - Street 2:
Practice Address - City:WOODRUFF
Practice Address - State:SC
Practice Address - Zip Code:29388-1953
Practice Address - Country:US
Practice Address - Phone:864-476-8315
Practice Address - Fax:864-476-6150
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCD43721223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice