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General NPI Number Information
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NPI Number | 1114445616
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Entity Type | Individual
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Provider Name | ADAM A TAEE DMD, CAGS, MSD
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Gender | Male
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 09/06/2019
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Provider Practice Location Address
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Address Line | 3076 SCHOENERSVILLE RD # 101
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City | BETHLEHEM
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State | PA
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Zip | 18017-2210
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Country | US
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Telephone | 610-978-5830
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Fax |
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Provider Business Mailing Address
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Address Line | 1308 KNOX WAY
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City | MOUNT LAUREL
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State | NJ
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Zip | 08054-0027
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Country | US
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Telephone | 617-756-7788
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN1857469
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | DS042093
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License Number State | PA
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