=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104990548
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | E-Z DENTISTRY
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/18/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 415 AVENEL ST
-----------------------------------------------------
City | AVENEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07001-1147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-636-7888
-----------------------------------------------------
Fax | 732-636-7887
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 415 AVENEL ST
-----------------------------------------------------
City | AVENEL
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07001-1147
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 732-636-7888
-----------------------------------------------------
Fax | 732-636-7887
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DENTIST
-----------------------------------------------------
Name | DR. SALMAN ADAMS
-----------------------------------------------------
Credential | DMD
-----------------------------------------------------
Telephone | 732-636-7888
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number | 22D101802700
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------