Provider Demographics
NPI:1548708878
Name:ROBERT WHEATLEY DDS INC
Entity type:Organization
Organization Name:ROBERT WHEATLEY DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:T
Authorized Official - Last Name:WHEATLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:636-947-6080
Mailing Address - Street 1:1360 S 5TH ST
Mailing Address - Street 2:SUITE 270
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63301-2449
Mailing Address - Country:US
Mailing Address - Phone:636-947-6080
Mailing Address - Fax:
Practice Address - Street 1:1360 S 5TH ST
Practice Address - Street 2:SUITE 270
Practice Address - City:SAINT CHARLES
Practice Address - State:MO
Practice Address - Zip Code:63301-2449
Practice Address - Country:US
Practice Address - Phone:636-947-6080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-07
Last Update Date:2017-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0143471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty