Individual provider Active NPI

Wade Combs, DMD

  • Dentist
  • St Petersburg, FL
National Provider Identifier
1407385107
Registry record updated Jun 6, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
DN22627 Issued in FL
Practice address
11018 4TH St N
St Petersburg, FL 33716-2945
Phone
(727) 577-3844
NPI assigned
Jun 6, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 6, 2017

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X DN22627 FL Primary

Addresses

Primary practice location

11018 4TH St N
St Petersburg, FL 33716-2945

Mailing address

17 Colonial CT
Palm Coast, FL 32137-8391

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20170811001571 FL Order and Referring Only - Oral SurgeryPractitioner - Oral Surgery 6204107014

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

Practice roles

OrganizationSpecialtyStatusNew patients
Coast Florida P.a. Dentist PastSince Jun 22, 2021 Accepting new patients
Coast Florida P.a. Dentist Past Accepting new patients

Organizations & group practices 2

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.

NPI Registry JSON

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1496707200000",
    "number": "1407385107",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17 COLONIAL CT",
            "city": "PALM COAST",
            "state": "FL",
            "postal_code": "321378391"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11018 4TH ST N",
            "city": "ST PETERSBURG",
            "state": "FL",
            "postal_code": "337162945",
            "telephone_number": "727-577-3844"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "COMBS",
        "first_name": "WADE",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2017-06-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "FL",
            "license": "DN22627",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in St Petersburg, FL

Sources for this page

Verify at the official NPI Registry.