Provider Demographics
NPI:1598848806
Name:HARRIS, WADE KELLY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:KELLY
Last Name:HARRIS
Suffix:
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 1:307A FOUST ST
Mailing Address - Street 2:
Mailing Address - City:ASHEBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27203-5405
Mailing Address - Country:US
Mailing Address - Phone:336-625-4137
Mailing Address - Fax:336-625-1452
Practice Address - Street 1:307A FOUST ST
Practice Address - Street 2:
Practice Address - City:ASHEBORO
Practice Address - State:NC
Practice Address - Zip Code:27203-5405
Practice Address - Country:US
Practice Address - Phone:336-625-4137
Practice Address - Fax:336-625-1452
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice