Jamie Wade, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

D12812 Issued in MN

Practice address

927 Trettel Lane
Fond Du Lac Human Services Division927 Trettel Lane
Cloquet, MN 55720

Phone

(218) 879-1227

Fax

(218) 878-3755

NPI assigned

Jul 14, 2010

Last updated

Apr 10, 2012By the provider in NPPES

Sex

Female

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 MN

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": "1279065600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1334016000000",
    "number": "1881906287",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION927 TRETTEL LANE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3755"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "927 TRETTEL LANE",
            "address_2": "FOND DU LAC HUMAN SERVICES DIVISION927 TRETTEL LANE",
            "city": "CLOQUET",
            "state": "MN",
            "postal_code": "55720",
            "telephone_number": "218-879-1227",
            "fax_number": "218-878-3755"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WADE",
        "first_name": "JAMIE",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2010-07-14",
        "last_updated": "2012-04-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "MN",
            "license": "D12812",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Vision Pro
• Paul John Vollmar Jr., M.D.
• Steven Buster Vopat, M.D.
• Joey Vork, RN, CNP
• Amy Vredenburgh, M.A., L.M.F.T.
• Wal-Mart Stores, Inc. (Vision Center 30-1929)
• Walgreen Co (Walgreens #15439)
• Walmart Inc. (Walmart Pharmacy 10-1929)
• Kelly Marie Warren, PHARMD
• Nicole Waters, MA, CCC-SLP

• General Practice Dentistry in Cloquet, MN
• Providers in Cloquet, MN by specialty
• General Practice Dentistry in Minnesota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 2012; 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.