Individual provider Active NPI

Leslie Dean Wheeler, DDS

  • Dentist
  • Dallas, OR
National Provider Identifier
1962570366
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
D6002 Issued in OR
Practice address
289 E Ellendale Ave
Suite 204
Dallas, OR 97338-1580
Phone
(503) 623-2666
NPI assigned
Dec 1, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X D6002 OR Primary

Addresses

Primary practice location

289 E Ellendale Ave
Suite 204
Dallas, OR 97338-1580

Mailing address

7240 Hilda St SE
Salem, OR 97301-9255
Phone (503) 588-8751

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in OR
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
I20160127000013 OR Order and Referring Only - DentistPractitioner - Dentist 7618270562

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
D6002ORMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
James Dental Group PC Dentist PastSince Jul 1, 2022 Accepting new patients

Organizations & group practices 1

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": "1164931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1962570366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7240 HILDA ST SE",
            "city": "SALEM",
            "state": "OR",
            "postal_code": "973019255",
            "telephone_number": "503-588-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "289 E ELLENDALE AVE",
            "address_2": "SUITE 204",
            "city": "DALLAS",
            "state": "OR",
            "postal_code": "973381580",
            "telephone_number": "503-623-2666"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WHEELER",
        "first_name": "LESLIE",
        "middle_name": "DEAN",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-01",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "OR",
            "license": "D6002",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, OR

Sources for this page

Verify at the official NPI Registry.