Individual
DR. ANDREW WAKEFIELD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
1061 S STATE ROUTE 260, COTTONWOOD, AZ 86326-4624
(928) 239-3254
Mailing address
574 S AMANTE DR, CORNVILLE, AZ 86325-5155
(440) 539-7009
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D011058
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
829258933
AMERICAN DENTAL ASSOCIATION
—
Enumeration date
06/17/2021
Last updated
06/17/2021
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