Marshall Lloyd Wade, D.D.S.

Primary specialty

Oral and Maxillofacial Surgery (Dentist)Taxonomy code 1223S0112X

License

D9734 Issued in MN

Practice address

1560 Beam Ave Ste E
Maplewood, MN 55109-1171

Phone

(651) 578-7000

Fax

(651) 773-9646

NPI assigned

Apr 6, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Maplewood Oral and Maxillofacial Surgery, P.a.

  • Oral and Maxillofacial Surgery (Dentist)
  • Woodbury, MN
  • NPI 1003993304
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1144281600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1386606937",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9950 VALLEY CREEK RD",
            "address_2": "SUITE100",
            "city": "WOODBURY",
            "state": "MN",
            "postal_code": "551254883",
            "telephone_number": "651-578-7000",
            "fax_number": "651-578-0157"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1560 BEAM AVE STE E",
            "city": "MAPLEWOOD",
            "state": "MN",
            "postal_code": "551091171",
            "telephone_number": "651-578-7000",
            "fax_number": "651-773-9646"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9950 Valley Creek Rd",
            "address_2": "Suite100",
            "address_purpose": "LOCATION",
            "city": "Woodbury",
            "state": "MN",
            "postal_code": "551254883",
            "country_code": "US",
            "telephone_number": "651-578-7000",
            "fax_number": "651-578-0157",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1420 Lake St S Ste 200",
            "address_purpose": "LOCATION",
            "city": "Forest Lake",
            "state": "MN",
            "postal_code": "550252713",
            "country_code": "US",
            "telephone_number": "651-578-7000",
            "fax_number": "651-464-8013",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "MARSHALL",
        "middle_name": "LLOYD",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-04-06",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223S0112X",
            "taxonomy_group": "",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "MN",
            "license": "D9734",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TAXONOMY NUMBER",
            "identifier": "1223S0112X",
            "state": "MN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DENTAL LICENSE",
            "identifier": "D9734",
            "state": "MN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "772822100",
            "state": "MN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Von Weiss
• Maulin Upendra Vora, M.B.B.S
• Jana Lynne Voss, DDS
• Joanne Berthiaume Votel, MD
• Mai Neng Vue
• Feyissa Jafar Wagesso
• Mark W Waggener, MD
• Meera Wagley
• Jessica Anne Wahl, NP
• Walgreen Co

• Oral and Maxillofacial Surgery (Dentist) in Maplewood, MN
• Providers in Maplewood, MN by specialty
• Oral and Maxillofacial Surgery (Dentist) in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.