MEDICARE: ADAMS SOUTHERN DENTAL ARTS, LLC

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

General Provider Information

NPI Number	:	1114594934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAMS SOUTHERN DENTAL ARTS, LLC

Provider Business Mailing Address
First Line	:	2045 BROOKWOOD MEDICAL CTR DR STE 6
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6809
Country	:	US
Telephone Number	:	205-326-7444
Fax Number	:	205-637-1933

Provider Business Practice Location Address
First Line	:	2045 BROOKWOOD MEDICAL CTR DR STE 6
Second Line	:
City	:	HOMEWOOD
State	:	AL
Zip	:	35209-6809
Country	:	US
Telephone Number	:	205-326-7444
Fax Number	:	205-637-1933

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. PRESTON ADAMS
Credential	:	DMD
Telephone Number	:	205-326-7444

Provider Enumeration Date	:	06/09/2021
Last Update Date	:	06/09/2021

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