Provider Demographics
NPI:1033467568
Name:HINRICHS, WADE ALLEN (DDS)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:ALLEN
Last Name:HINRICHS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4210 PICO NORTE LN NE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-6391
Mailing Address - Country:US
Mailing Address - Phone:804-399-2697
Mailing Address - Fax:
Practice Address - Street 1:13031 CENTRAL AVE NE
Practice Address - Street 2:COMFORT DENTAL CENTRAL
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87123-3029
Practice Address - Country:US
Practice Address - Phone:505-332-2273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-15
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28032122300000X
NMDD4481122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist