Healthcare Provider Details

I. General information

NPI: 1295664191
Provider Name (Legal Business Name): SAMUEL WAKEFIELD DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/16/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4225 TALMADGE RD
TOLEDO OH
43623-3505
US

IV. Provider business mailing address

20127 ANTAGO ST
LIVONIA MI
48152-2403
US

V. Phone/Fax

Practice location:
  • Phone: 419-241-2800
  • Fax:
Mailing address:
  • Phone: 248-469-6243
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30.028619
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: