MEDICARE: DR. RANDALL ADAMS D.M.D., M.S.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223X0400X	Orthodontics and Dentofacial Orthopedics Dentistry	AZ2716	AZ

General Provider Information

NPI Number	:	1023149119
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RANDALL ADAMS D.M.D., M.S.D.

Provider Business Mailing Address
First Line	:	2835 E BROWN RD STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5470
Country	:	US
Telephone Number	:	480-832-3830
Fax Number	:	480-924-9147

Provider Business Practice Location Address
First Line	:	2835 E BROWN RD STE 102
Second Line	:
City	:	MESA
State	:	AZ
Zip	:	85213-5470
Country	:	US
Telephone Number	:	480-832-3830
Fax Number	:	480-924-9147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2007
Last Update Date	:	07/08/2007

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