Provider Demographics
NPI:1063030559
Name:GADE, PRADEEP
Entity Type:Individual
Prefix:
First Name:PRADEEP
Middle Name:
Last Name:GADE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5160 FRANZ RD # 1B
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77493-1763
Mailing Address - Country:US
Mailing Address - Phone:281-371-3368
Mailing Address - Fax:
Practice Address - Street 1:1501 W STOUT ST
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-5001
Practice Address - Country:US
Practice Address - Phone:412-689-2172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-10
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363071223G0001X
WI1002502-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice