Healthcare Provider Details

I. General information

NPI: 1720755804
Provider Name (Legal Business Name): ADAMS MICRO ENDODONTICS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/25/2021
Last Update Date: 06/20/2023
Certification Date: 06/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR STE 430
LA MESA CA
91942-7001
US

IV. Provider business mailing address

8860 CENTER DR STE 430
LA MESA CA
91942-7001
US

V. Phone/Fax

Practice location:
  • Phone: 619-510-3566
  • Fax:
Mailing address:
  • Phone: 619-713-6600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223E0200X
TaxonomyEndodontics
License Number
License Number State

VIII. Authorized Official

Name: MONA ADAMS
Title or Position: OWNER
Credential:
Phone: 216-302-8790