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General NPI Number Information
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NPI Number | 1891843637
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Entity Type | Organization
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Legal Business Name | DRS. SLABY, ADAMS AND TIETJENS, LTD.
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Dates
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Enumeration Date | 01/08/2007
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Last Update Date | 03/31/2009
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Provider Practice Location Address
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Address Line | 750 ALMAR PKWY SUITE 102
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2315
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Country | US
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Telephone | 815-939-7136
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Fax | 815-939-9820
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Provider Business Mailing Address
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Address Line | 750 ALMAR PKWY SUITE 102
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City | BOURBONNAIS
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State | IL
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Zip | 60914-2315
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Country | US
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Telephone | 815-939-7136
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Fax | 815-939-9820
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES MATTHEW ADAMS
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Credential | DDS
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Telephone | 815-939-7136
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 060002115
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License Number State | IL
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