Provider Demographics
NPI:1023097367
Name:OWENS, WADE HAMPTON (DDS)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:HAMPTON
Last Name:OWENS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:MR
Other - First Name:WADE
Other - Middle Name:HAMPTON
Other - Last Name:OWENS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:UNITED STATES MILITARY ACADEMY
Mailing Address - Street 2:646 SWIFT ROAD, BLDG 606
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1942
Mailing Address - Country:US
Mailing Address - Phone:845-938-2449
Mailing Address - Fax:845-938-2449
Practice Address - Street 1:UNITED STATES MILITARY ACADEMY
Practice Address - Street 2:646 SWIFT ROAD, BLDG 606
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1942
Practice Address - Country:US
Practice Address - Phone:845-938-2449
Practice Address - Fax:845-938-2449
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2023-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000105341223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics