Provider Demographics
NPI:1649214453
Name:CARNES, WADE E (DDS)
Entity Type:Individual
Prefix:
First Name:WADE
Middle Name:E
Last Name:CARNES
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 1:4318 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46241-0822
Mailing Address - Country:US
Mailing Address - Phone:317-241-9876
Mailing Address - Fax:317-247-4877
Practice Address - Street 1:4318 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46241-0822
Practice Address - Country:US
Practice Address - Phone:317-241-9876
Practice Address - Fax:317-247-4877
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120071401223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice