Provider Demographics
NPI:1710728563
Name:WADE FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:WADE FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MASON
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:843-795-4255
Mailing Address - Street 1:1626 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3201
Mailing Address - Country:US
Mailing Address - Phone:843-795-4255
Mailing Address - Fax:
Practice Address - Street 1:1626 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3201
Practice Address - Country:US
Practice Address - Phone:843-795-4255
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental