Healthcare Provider Details

I. General information

NPI: 1265543177
Provider Name (Legal Business Name): DAVID C ADAMS D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

420 SPRUCE ST SUITE B
SAN DIEGO CA
92103-5800
US

IV. Provider business mailing address

736 STAFFORD PL
SAN DIEGO CA
92107-4241
US

V. Phone/Fax

Practice location:
  • Phone: 619-291-5266
  • Fax: 619-291-0124
Mailing address:
  • Phone: 619-291-5266
  • Fax: 619-291-0124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License Number36511
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number36511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: