=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366726531
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CALLY L. ADAMS, DDS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/05/2011
-----------------------------------------------------
Last Update Date | 10/05/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1325 S KIHEI RD SUITE 108
-----------------------------------------------------
City | KIHEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96753-8179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-875-4808
-----------------------------------------------------
Fax | 808-875-4841
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1325 S KIHEI RD SUITE 108
-----------------------------------------------------
City | KIHEI
-----------------------------------------------------
State | HI
-----------------------------------------------------
Zip | 96753-8179
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 808-875-4808
-----------------------------------------------------
Fax | 808-875-4841
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PEDIATRIC DENTIST
-----------------------------------------------------
Name | DR. CALLY L ADAMS
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 808-875-4808
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223P0221X
-----------------------------------------------------
Taxonomy Name | Pediatric Dentistry
-----------------------------------------------------
License Number | DT2289
-----------------------------------------------------
License Number State | HI
-----------------------------------------------------