Provider Demographics
NPI:1659820207
Name:CURTIS K. WADE, DDS,PS
Entity Type:Organization
Organization Name:CURTIS K. WADE, DDS,PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:GLENDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:GUNDERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-757-0201
Mailing Address - Street 1:205 W FAIRHAVEN AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:BURLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98233-1062
Mailing Address - Country:US
Mailing Address - Phone:360-757-0201
Mailing Address - Fax:360-757-1990
Practice Address - Street 1:205 W FAIRHAVEN AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BURLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98233-1062
Practice Address - Country:US
Practice Address - Phone:360-757-0201
Practice Address - Fax:360-757-1990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-23
Last Update Date:2016-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA5108OtherPERIODONTICS