Individual
DR. MITZI M. WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
2016 MAIN AVE SW, CULLMAN, AL 35055-5239
(256) 775-0230
(256) 735-0943
Mailing address
PO BOX 97, GADSDEN, AL 35902-0097
(256) 492-0131
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
8793
TN
1223G0001X
General Practice Dentistry
Primary
5792
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
122611
—
AL
05
—
122617
—
AL
Enumeration date
01/09/2008
Last updated
03/29/2011
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