MEDICARE: DR. TODD S ADAMS DDS

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	1223G0001X	General Practice Dentistry	13196763-9921	UT
2	1223G0001X	General Practice Dentistry	56025	CA
3	1223G0001X	General Practice Dentistry	D-5485	ID

General Provider Information

NPI Number	:	1033308689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD S ADAMS DDS

Provider Business Mailing Address
First Line	:	4702 N PENNGROVE WAY STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-7449
Country	:	US
Telephone Number	:	208-938-1825
Fax Number	:	208-938-5763

Provider Business Practice Location Address
First Line	:	4702 N PENNGROVE WAY STE 100
Second Line	:
City	:	MERIDIAN
State	:	ID
Zip	:	83646-7449
Country	:	US
Telephone Number	:	208-938-1825
Fax Number	:	208-938-5763

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

Provider Enumeration Date	:	10/19/2007
Last Update Date	:	09/09/2024

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Directions to “ DR. TODD S ADAMS DDS” Practice Location

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