Provider Demographics
NPI:1366558306
Name:MARKHAM, DAVID WADE (DDS)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WADE
Last Name:MARKHAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P O BOX 472145
Mailing Address - Street 2:6415 BANNINGTON DRIVE
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28247
Mailing Address - Country:US
Mailing Address - Phone:704-541-1193
Mailing Address - Fax:704-541-0937
Practice Address - Street 1:6415 BANNINGTON DRIVE
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28226
Practice Address - Country:US
Practice Address - Phone:704-541-1193
Practice Address - Fax:704-541-0937
Is Sole Proprietor?:No
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC64541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice