Individual
CHAD WADE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 636-3892
(360) 414-1114
Mailing address
1057 12TH AVE, LONGVIEW, WA 98632-2509
(360) 636-3892
(360) 414-1114
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DE60041682
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
5058177
—
WA
Enumeration date
10/08/2008
Last updated
12/13/2011
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