Provider Demographics
NPI:1518163690
Name:WADE, ANDREW B (DDS,MS)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:B
Last Name:WADE
Suffix:
Gender:M
Credentials:DDS,MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5249 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43228-5606
Mailing Address - Country:US
Mailing Address - Phone:614-878-7887
Mailing Address - Fax:614-878-4134
Practice Address - Street 1:5249 W BROAD ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-5606
Practice Address - Country:US
Practice Address - Phone:614-878-7887
Practice Address - Fax:614-878-4134
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH207221223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics