Provider Demographics
NPI:1669928305
Name:WADE, MASON (DMD)
Entity type:Individual
Prefix:
First Name:MASON
Middle Name:
Last Name:WADE
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1626 HARBOR VIEW RD
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:SC
Mailing Address - Zip Code:29412-3201
Mailing Address - Country:US
Mailing Address - Phone:843-795-4255
Mailing Address - Fax:
Practice Address - Street 1:1626 HARBOR VIEW RD
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:SC
Practice Address - Zip Code:29412-3201
Practice Address - Country:US
Practice Address - Phone:843-795-4255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-01
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC87771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice