Provider Demographics
NPI:1598790750
Name:WADE, SEABORN MCDONALD JR (DDS)
Entity Type:Individual
Prefix:
First Name:SEABORN
Middle Name:MCDONALD
Last Name:WADE
Suffix:JR
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 1:5700 OLD RICHMOND AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23226-1828
Mailing Address - Country:US
Mailing Address - Phone:804-285-7550
Mailing Address - Fax:
Practice Address - Street 1:5700 OLD RICHMOND AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23226-1828
Practice Address - Country:US
Practice Address - Phone:804-285-7550
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA40311223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics