Provider Demographics
NPI:1275543233
Name:MENDENHALL, WADE ARTHUR (DDS)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:ARTHUR
Last Name:MENDENHALL
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:10665 W INDIAN SCHOOL RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323
Mailing Address - Country:US
Mailing Address - Phone:623-772-5362
Mailing Address - Fax:623-772-6036
Practice Address - Street 1:10665 W INDIAN SCHOOL RD
Practice Address - Street 2:SUITE J
Practice Address - City:AVONDALE
Practice Address - State:AZ
Practice Address - Zip Code:85323
Practice Address - Country:US
Practice Address - Phone:623-772-5362
Practice Address - Fax:623-772-6036
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52591223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ538340OtherAPIPA
AZ538340OtherMERCY CARE
53840OtherCDMP
AZAZ0498470OtherBCBS OF AZ
AZ666280OtherUNITED CONCORDIA