Healthcare Provider Details

I. General information

NPI: 1851557581
Provider Name (Legal Business Name): MATTHEW JAMES ADAMO DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2008
Last Update Date: 08/26/2021
Certification Date: 08/26/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG H100 SANTA MARGERITA RD NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

IV. Provider business mailing address

BLDG H100 SANTA MARGERITA RD NAVAL HOSPITAL CAMP PENDLETON
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-1200
  • Fax: 760-725-1267
Mailing address:
  • Phone: 760-725-1200
  • Fax: 760-725-1267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDDS58942
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: