Provider Demographics
NPI:1932591450
Name:HADAWAY, WAYNE JR (DDS)
Entity Type:Individual
Prefix:
First Name:WAYNE
Middle Name:
Last Name:HADAWAY
Suffix:JR
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 1:1338 WILBUR AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92109-2135
Mailing Address - Country:US
Mailing Address - Phone:858-488-8338
Mailing Address - Fax:
Practice Address - Street 1:2036 HORNBLEND ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-4638
Practice Address - Country:US
Practice Address - Phone:858-488-8338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-19
Last Update Date:2015-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23509122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist