Healthcare Provider Details

I. General information

NPI: 1598790750
Provider Name (Legal Business Name): SEABORN MCDONALD WADE JR. D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5700 OLD RICHMOND AVE
RICHMOND VA
23226-1828
US

IV. Provider business mailing address

5700 OLD RICHMOND AVE
RICHMOND VA
23226-1828
US

V. Phone/Fax

Practice location:
  • Phone: 804-285-7550
  • Fax:
Mailing address:
  • Phone: 804-285-7550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number4031
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: