Provider Demographics
NPI:1053323964
Name:HADEN, ROBERT WADE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WADE
Last Name:HADEN
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 1:1500 GUNTER AVE
Mailing Address - Street 2:
Mailing Address - City:GUNTERSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35976-1848
Mailing Address - Country:US
Mailing Address - Phone:256-582-6869
Mailing Address - Fax:256-582-6872
Practice Address - Street 1:1500 GUNTER AVE
Practice Address - Street 2:
Practice Address - City:GUNTERSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35976-1848
Practice Address - Country:US
Practice Address - Phone:256-582-6869
Practice Address - Fax:256-582-6872
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL30411223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice