Provider Demographics
NPI:1821565490
Name:WADE, JULIAN ANTHONY (DDS)
Entity Type:Individual
Prefix:DR
First Name:JULIAN
Middle Name:ANTHONY
Last Name:WADE
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 1:31445 PEAR BLOSSOM CIR
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-6238
Mailing Address - Country:US
Mailing Address - Phone:202-640-9586
Mailing Address - Fax:
Practice Address - Street 1:5060 LOGAN AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92113-3014
Practice Address - Country:US
Practice Address - Phone:619-262-0706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-31
Last Update Date:2018-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1033381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice