Provider Demographics
NPI:1447477443
Name:PHELPS, WADE L (DDS)
Entity type:Individual
Prefix:DR
First Name:WADE
Middle Name:L
Last Name:PHELPS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:310 W OAKLAWN RD
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:TX
Mailing Address - Zip Code:78064-4033
Mailing Address - Country:US
Mailing Address - Phone:830-569-8940
Mailing Address - Fax:830-224-6905
Practice Address - Street 1:757 S PANNA MARIA AVE
Practice Address - Street 2:
Practice Address - City:KARNES CITY
Practice Address - State:TX
Practice Address - Zip Code:78118-3808
Practice Address - Country:US
Practice Address - Phone:830-780-3100
Practice Address - Fax:830-780-3130
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX124821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice