Provider Demographics
NPI:1710432885
Name:ELTON, WADE MURRAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:WADE
Middle Name:MURRAY
Last Name:ELTON
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 1:1020 15TH ST APT 22C
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80202-2310
Mailing Address - Country:US
Mailing Address - Phone:320-262-2330
Mailing Address - Fax:
Practice Address - Street 1:2620 TENDERFOOT HILL ST STE 210
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80906-8356
Practice Address - Country:US
Practice Address - Phone:719-597-7979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-18
Last Update Date:2016-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN.00202963122300000X
MND13731122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist