MEDICARE: LYDE J. ADAMS, D.D.S. INC.

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	1223E0200X	Endodontics

General Provider Information

NPI Number	:	1023436276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LYDE J. ADAMS, D.D.S. INC.

Provider Business Mailing Address
First Line	:	2525 W MAIN ST
Second Line	:	STE # 206
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0901
Country	:	US
Telephone Number	:	605-348-4868
Fax Number	:	605-737-7870

Provider Business Practice Location Address
First Line	:	2525 W MAIN ST
Second Line	:	STE # 206
City	:	RAPID CITY
State	:	SD
Zip	:	57702-0901
Country	:	US
Telephone Number	:	605-348-4868
Fax Number	:	605-737-7870

Authorized Official
Title or Position	:	ENDODONTIST
Name	:	DR. LYDE JEFFERSON ADAMS
Credential	:	D.D.S.
Telephone Number	:	605-348-4868

Provider Enumeration Date	:	04/04/2014
Last Update Date	:	04/04/2014

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