Healthcare Provider Details

I. General information

NPI: 1285314856
Provider Name (Legal Business Name): ANNALEE ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2023
Last Update Date: 07/19/2023
Certification Date: 07/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HIGHWAY 80
MANCHESTER KY
40962-8801
US

IV. Provider business mailing address

402 W KENTUCKY AVE
PINEVILLE KY
40977-1306
US

V. Phone/Fax

Practice location:
  • Phone: 606-596-0410
  • Fax: 606-598-1117
Mailing address:
  • Phone: 606-269-8404
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number10940
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: