Provider Demographics
NPI:1720092133
Name:WADE, PAMELA SUE (DDS)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:SUE
Last Name:WADE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:SUE
Other - Last Name:CERMAK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:1000 MERIDIAN BLVD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:FRANKLIN
Mailing Address - State:TN
Mailing Address - Zip Code:37067-6344
Mailing Address - Country:US
Mailing Address - Phone:615-771-8809
Mailing Address - Fax:
Practice Address - Street 1:1000 MERIDIAN BLVD
Practice Address - Street 2:SUITE 108
Practice Address - City:FRANKLIN
Practice Address - State:TN
Practice Address - Zip Code:37067-6344
Practice Address - Country:US
Practice Address - Phone:615-771-8809
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2019-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH0185731223G0001X
TN87321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice