Healthcare Provider Details

I. General information

NPI: 1912575564
Provider Name (Legal Business Name): SPENCER DEAN ADAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2021
Last Update Date: 06/10/2021
Certification Date: 06/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2810 S 48TH ST
LINCOLN NE
68506-3391
US

IV. Provider business mailing address

2810 S 48TH ST
LINCOLN NE
68506-3391
US

V. Phone/Fax

Practice location:
  • Phone: 402-483-4171
  • Fax:
Mailing address:
  • Phone: 402-483-4171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number7715
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: