Provider Demographics
NPI:1346478062
Name:ETCHESON, AARON WADE (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:AARON
Middle Name:WADE
Last Name:ETCHESON
Suffix:
Gender:M
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23609 N CENTENNIAL RD
Mailing Address - Street 2:
Mailing Address - City:JERSEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62052-6286
Mailing Address - Country:US
Mailing Address - Phone:618-530-1868
Mailing Address - Fax:
Practice Address - Street 1:23609 N CENTENNIAL RD
Practice Address - Street 2:
Practice Address - City:JERSEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62052-6286
Practice Address - Country:US
Practice Address - Phone:618-530-1868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-01
Last Update Date:2009-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001620471223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics