Keith Wade, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

7350 Issued in CT

Practice address

101 Main St S
Box 640
Bethlehem, CT 06751-2032

Phone

(203) 266-7435

Fax

(203) 266-5100

NPI assigned

Mar 15, 2007

Last updated

Jul 8, 2007By the provider in NPPES

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

Medicare fee-for-service enrollment

Enrolled in CT

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

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

{
    "created_epoch": "1173916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1649304361",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "101 MAIN ST S",
            "address_2": "BOX 640",
            "city": "BETHLEHEM",
            "state": "CT",
            "postal_code": "067512032",
            "telephone_number": "203-266-7435",
            "fax_number": "203-266-5100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "101 MAIN ST S",
            "address_2": "BOX 640",
            "city": "BETHLEHEM",
            "state": "CT",
            "postal_code": "067512032",
            "telephone_number": "203-266-7435",
            "fax_number": "203-266-5100"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "KEITH",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-03-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CT",
            "license": "7350",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Cheyanne Inez Smith, LMFT
• The Wellspring Foundation, Inc.
• Towne Apothecary LLC
• Towne RX Inc
• Lisa Zinn Tuz, BCBA CTLBA
• Andrew C. Wells, M.D.
• Maureen Williams

• General Practice Dentistry in Bethlehem, CT
• Providers in Bethlehem, CT by specialty
• General Practice Dentistry in Connecticut

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.