Provider Demographics
NPI:1437152261
Name:DAVIS, WADE TAYLOR III (DDS)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:TAYLOR
Last Name:DAVIS
Suffix:III
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 1:1115 HICKS BLVD
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45014-2889
Mailing Address - Country:US
Mailing Address - Phone:513-829-8830
Mailing Address - Fax:513-829-1186
Practice Address - Street 1:1115 HICKS BLVD
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:OH
Practice Address - Zip Code:45014-2889
Practice Address - Country:US
Practice Address - Phone:513-829-8830
Practice Address - Fax:513-829-1186
Is Sole Proprietor?:No
Enumeration Date:2005-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH134581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice