Healthcare Provider Details

I. General information

NPI: 1083772438
Provider Name (Legal Business Name): RICHARD CLAYTON ADAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

413 OWENS DRIVE SUITE 102
FAYETTEVILLE NC
28304
US

IV. Provider business mailing address

2641 LOCKWOOD RD SUITE 103
FAYETTEVILLE NC
28303-5020
US

V. Phone/Fax

Practice location:
  • Phone: 910-496-9400
  • Fax: 910-496-9402
Mailing address:
  • Phone: 910-778-9746
  • Fax: 910-778-9746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number7054
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: