MEDICARE: NEIL D ADAMSON DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	D-1620	ID

General Provider Information

NPI Number	:	1588748529
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEIL D ADAMSON DDS

Provider Business Mailing Address
First Line	:	270 E 5TH N
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2749
Country	:	US
Telephone Number	:	208-587-9031
Fax Number	:	208-587-9031

Provider Business Practice Location Address
First Line	:	270 E 5TH N
Second Line	:
City	:	MOUNTAIN HOME
State	:	ID
Zip	:	83647-2749
Country	:	US
Telephone Number	:	208-587-9031
Fax Number	:	208-587-9031

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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