Provider Demographics
NPI:1275700171
Name:FAWCETT, WAYDE (DDS)
Entity Type:Individual
Prefix:
First Name:WAYDE
Middle Name:
Last Name:FAWCETT
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 1:13956 CUTTEN RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77069-2215
Mailing Address - Country:US
Mailing Address - Phone:281-440-6648
Mailing Address - Fax:281-440-4120
Practice Address - Street 1:13956 CUTTEN RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77069-2215
Practice Address - Country:US
Practice Address - Phone:281-440-6648
Practice Address - Fax:281-440-4120
Is Sole Proprietor?:No
Enumeration Date:2008-05-11
Last Update Date:2008-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX143011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX459941OtherUCCI