MEDICARE: NATHAN G ADAMS DMD, MD

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	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	7961990-9924	UT
2	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	7961990-1205	UT
3	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	54019	MN
4	204E00000X	Oral & Maxillofacial Surgery (D.M.D.)	D12304	MN

General Provider Information

NPI Number	:	1174604128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATHAN G ADAMS DMD, MD

Provider Business Mailing Address
First Line	:	1250 E 3900 S STE 360
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1362
Country	:	US
Telephone Number	:	801-262-7447
Fax Number	:	801-262-7450

Provider Business Practice Location Address
First Line	:	1250 E 3900 S STE 360
Second Line	:
City	:	SALT LAKE CITY
State	:	UT
Zip	:	84124-1362
Country	:	US
Telephone Number	:	801-262-7447
Fax Number	:	801-262-7450

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	11/12/2024

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