Provider Demographics
NPI:1427798941
Name:WADE AND GHORBANIAN DDS INC.
Entity type:Organization
Organization Name:WADE AND GHORBANIAN DDS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIAN
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:WADE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:858-573-2833
Mailing Address - Street 1:4428 CONVOY ST STE 230
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111-3761
Mailing Address - Country:US
Mailing Address - Phone:858-573-2833
Mailing Address - Fax:
Practice Address - Street 1:4428 CONVOY ST STE 230
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111-3761
Practice Address - Country:US
Practice Address - Phone:858-573-2833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental