Healthcare Provider Details

I. General information

NPI: 1457394140
Provider Name (Legal Business Name): MARK ALLAN MCADAMS DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 S RANCH HOUSE RD STE 1200
ALEDO TX
76008-2691
US

IV. Provider business mailing address

108 S RANCH HOUSE RD STE 1200
ALEDO TX
76008-2663
US

V. Phone/Fax

Practice location:
  • Phone: 817-441-8003
  • Fax: 817-441-8223
Mailing address:
  • Phone: 817-441-8003
  • Fax: 817-441-8223

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number16368
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: