Individual provider Active NPI

John Hardie Wheelock, DDS

  • Oral and Maxillofacial Surgery (Dentist)
  • El Paso, TX
National Provider Identifier
1104453075
Registry record updated Apr 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X
License
42189 Issued in TX
Practice address
10175 Gateway Blvd W Ste 304
El Paso, TX 79925-2203
Phone
(915) 504-6880
Fax
(915) 599-8579
NPI assigned
Mar 23, 2020
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Apr 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery (Dentist) 1223S0112X D011987 AZ
Oral and Maxillofacial Surgery (Dentist)Group: 193400000X SINGLE SPECIALTY GROUP 1223S0112X 42189 TX Primary

Addresses

Primary practice location

10175 Gateway Blvd W Ste 304
El Paso, TX 79925-2203

Mailing address

10175 Gateway Blvd W Ste 304
El Paso, TX 79925-2203
Phone (915) 504-6880

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in DE
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200707000841 DE Order and Referring Only - DentistPractitioner - Dentist 1658794854

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D011987AZMDOral and Maxillofacial Surgery (Dentist)

Practice roles

OrganizationSpecialtyStatusNew patients
Summit Dental Specialty PLLC CurrentSince Jun 30, 2024 Accepting new patients
West Texas Maxillofacial Surgery PA Single Specialty PastSince Jul 1, 2013 Accepting new patients

Locations

15810 S 45th St
Ste 120
Phoenix, AZ 85048
Phone (480) 753-1300

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1584921600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776297600000",
    "number": "1104453075",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10175 GATEWAY BLVD W STE 304",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799252203",
            "telephone_number": "915-504-6880",
            "fax_number": "915-599-8579"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10175 GATEWAY BLVD W STE 304",
            "city": "EL PASO",
            "state": "TX",
            "postal_code": "799252203",
            "telephone_number": "915-504-6880",
            "fax_number": "915-599-8579"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELOCK",
        "first_name": "JOHN",
        "middle_name": "HARDIE",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2020-03-23",
        "last_updated": "2026-04-16",
        "certification_date": "2026-04-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "AZ",
            "license": "D011987",
            "primary": false
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "TX",
            "license": "42189",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in El Paso, TX

Sources for this page

Verify at the official NPI Registry.