Provider Demographics
NPI:1780750570
Name:WAKEFIELD, CANDACE THERESE (DMD)
Entity type:Individual
Prefix:DR
First Name:CANDACE
Middle Name:THERESE
Last Name:WAKEFIELD
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1611 LOCUST ST
Mailing Address - Street 2:UNIT 501
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63103-1857
Mailing Address - Country:US
Mailing Address - Phone:314-588-1519
Mailing Address - Fax:
Practice Address - Street 1:10166 W FLORISSANT AVE
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63136-2104
Practice Address - Country:US
Practice Address - Phone:314-867-5650
Practice Address - Fax:314-867-5652
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20001752931223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry