Wade, Mitzi M.

Wade, Mitzi M. is an individual health care provider with primary practice located at 2016 Main Ave Sw , Cullman AL 35055-5239. She recently has 2 registered licenses in different health care specialties including Dental Providers / Dentist, Dental Providers / General Practice. Dental Providers / General Practice is her primary health care specialty. Wade, Mitzi M. can be contacted via phone (256) 775-0230.

Contact Information

Primary practice address
2016 Main Ave Sw Cullman AL 35055-5239
Phone: (256) 775-0230
Fax: (256) 735-0943
Website:
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Health care specialties

SpecialtyCodeLicense #State
Dental Providers / Dentist 122300000X 8793 Tennessee
Dental Providers / General Practice 1223G0001X 5792 Alabama

Profile Details

NPI number 1124203013
LBN Legal business name Wade, Mitzi M.
Credentials Doctor of Dental Surgery (DDS)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 9th, 2008
Last updated Mar 29th, 2011 - about 15 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124203013 NPPES
Alabama MEDICAID 122617
Alabama MEDICAID 122611

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