Healthcare Provider Details

I. General information

NPI: 1962750737
Provider Name (Legal Business Name): JENNIFER LYNN ADICKS D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2012
Last Update Date: 05/05/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

909 DAIRY ASHFORD RD SUITE 109
HOUSTON TX
77079-5309
US

IV. Provider business mailing address

909 DAIRY ASHFORD RD SUITE 109
HOUSTON TX
77079-5309
US

V. Phone/Fax

Practice location:
  • Phone: 281-752-0314
  • Fax:
Mailing address:
  • Phone: 281-752-0314
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number28148
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: