Provider Demographics
NPI:1457497018
Name:WADE, JEAN TERESA (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEAN
Middle Name:TERESA
Last Name:WADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 HOSPITAL DRIVE
Mailing Address - Street 2:
Mailing Address - City:ANDREWS
Mailing Address - State:TX
Mailing Address - Zip Code:79714
Mailing Address - Country:US
Mailing Address - Phone:432-523-4367
Mailing Address - Fax:432-524-2745
Practice Address - Street 1:612 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:ANDREWS
Practice Address - State:TX
Practice Address - Zip Code:79714-3615
Practice Address - Country:US
Practice Address - Phone:432-523-7782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16104122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist