1023097367 NPI number — DR. WADE HAMPTON OWENS DDS

Table of content: DR. WADE HAMPTON OWENS DDS (NPI 1023097367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023097367 NPI number — DR. WADE HAMPTON OWENS DDS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OWENS
Provider First Name:
WADE
Provider Middle Name:
HAMPTON
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DDS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OWENS
Provider Other First Name:
WADE
Provider Other Middle Name:
HAMPTON
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DDS
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1023097367
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
UNITED STATES MILITARY ACADEMY
Provider Second Line Business Mailing Address:
646 SWIFT ROAD, BLDG 606
Provider Business Mailing Address City Name:
WEST POINT
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10996-1942
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
845-938-2449
Provider Business Mailing Address Fax Number:
845-938-2449

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNITED STATES MILITARY ACADEMY
Provider Second Line Business Practice Location Address:
646 SWIFT ROAD, BLDG 606
Provider Business Practice Location Address City Name:
WEST POINT
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10996-1942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
845-938-2449
Provider Business Practice Location Address Fax Number:
845-938-2449
Provider Enumeration Date:
01/14/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1223P0700X , with the licence number:  DE00010534 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)