Healthcare Provider Details

I. General information

NPI: 1730460924
Provider Name (Legal Business Name): JESSICA LYNN ADAMS DDS MSD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 04/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 OLIVE WAY SUITE 810
SEATTLE WA
98101
US

IV. Provider business mailing address

720 OLIVE WAY SUITE 810
SEATTLE WA
98101
US

V. Phone/Fax

Practice location:
  • Phone: 206-628-0404
  • Fax: 206-628-0024
Mailing address:
  • Phone: 206-628-0404
  • Fax: 206-628-0024

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License NumberDE60228335
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: