Healthcare Provider Details

I. General information

NPI: 1639559727
Provider Name (Legal Business Name): ADAMS DENTAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2015
Last Update Date: 06/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 KINGS RD
MADISON NJ
07940-2016
US

IV. Provider business mailing address

1 KINGS RD
MADISON NJ
07940-2016
US

V. Phone/Fax

Practice location:
  • Phone: 973-377-6500
  • Fax:
Mailing address:
  • Phone: 973-377-6500
  • Fax: 973-377-6522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22D10795800
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License Number
License Number State

VIII. Authorized Official

Name: DR. ALLISON MERCY ADAMS
Title or Position: OWNER
Credential: DMD
Phone: 973-377-6500