Individual
DR. MARSHALL LLOYD WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.D.S.
Contact information
Practice address
1560 BEAM AVE STE E, MAPLEWOOD, MN 55109-1171
(651) 578-7000
(651) 773-9646
Mailing address
9950 VALLEY CREEK RD, SUITE100, WOODBURY, MN 55125-4883
(651) 578-7000
(651) 578-0157
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
Primary
D9734
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1223S0112X
TAXONOMY NUMBER
MN
05
—
772822100
—
MN
01
—
D9734
DENTAL LICENSE
MN
Enumeration date
04/06/2006
Last updated
07/21/2022
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