Spencer Glen Wade, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7033505-9921-8903 Issued in UT

Practice address

5139 S 1900 W
Roy, UT 84067-2997

Phone

(801) 773-7721

Fax

(801) 773-1657

NPI assigned

Feb 7, 2009

Last updated

Jul 21, 2022By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: swade297072@direct.med.utah.edu

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

{
    "created_epoch": "1233964800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1658361600000",
    "number": "1487893988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5139 S. 1900 W.",
            "city": "ROY",
            "state": "UT",
            "postal_code": "84067",
            "telephone_number": "801-773-7721",
            "fax_number": "801-773-1657"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5139 S 1900 W",
            "city": "ROY",
            "state": "UT",
            "postal_code": "840672997",
            "telephone_number": "801-773-7721",
            "fax_number": "801-773-1657"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "5621 S 7500 W",
            "address_purpose": "LOCATION",
            "city": "Hooper",
            "state": "UT",
            "postal_code": "843159746",
            "country_code": "US",
            "telephone_number": "801-820-5777",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WADE",
        "first_name": "SPENCER",
        "middle_name": "GLEN",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-07",
        "last_updated": "2022-07-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "UT",
            "license": "7033505-9921-8903",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Roy, UT
• Providers in Roy, UT by specialty
• General Practice Dentistry in Utah

• 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.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.