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NPI Code Detail

MEDICARE: MARY MICHELLE WADE RDH

MEDICARE: MARY MICHELLE WADE RDH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1124Q00000XDental HygienistH2787OR

General Provider Information

NPI Number : 1003828203
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY MICHELLE WADE RDH
Provider Business Mailing Address
First Line : 3062 SEMINOLE RD NE
Second Line :
City : SILVERTON
State : OR
Zip : 97381-9469
Country : US
Telephone Number : 503-873-5982
Fax Number :
Provider Business Practice Location Address
First Line : 2300 LANCASTER DR NE
Second Line :
City : SALEM
State : OR
Zip : 97305-1223
Country : US
Telephone Number : 503-370-4843
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2006
Last Update Date : 07/08/2007

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