Provider Demographics
NPI:1801971684
Name:WADAS, AMY J (DDS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:J
Last Name:WADAS
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 1:9307 CALUMET AVE
Mailing Address - Street 2:D2
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-2891
Mailing Address - Country:US
Mailing Address - Phone:219-836-2910
Mailing Address - Fax:
Practice Address - Street 1:9307 CALUMET AVE
Practice Address - Street 2:D2
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-2891
Practice Address - Country:US
Practice Address - Phone:219-836-2910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12009926A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice