Individual
SPENCER WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
345 E 24TH ST, NEW YORK, NY 10010-4020
(517) 285-8734
Mailing address
20 WATERSIDE PLZ APT 36G, NEW YORK, NY 10010-2618
(517) 285-8734
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
3705
OH
1223D0004X
Dental Anesthesiology
10310
KY
1223D0004X
Dental Anesthesiology
Primary
O61371
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5172858734
THE OHIO STATE UNIVERSITY
OH
Enumeration date
06/09/2016
Last updated
09/07/2021
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