MEDICARE: SHAWNA ADAM D.D.S.

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	122300000X	Dentist	25673	TX

General Provider Information

NPI Number	:	1235444217
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAWNA ADAM D.D.S.

Provider Business Mailing Address
First Line	:	108 LISBON CT APT 303
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-3192
Country	:	US
Telephone Number	:	979-218-5994
Fax Number	:

Provider Business Practice Location Address
First Line	:	USS MESA VERDE (LPD 19)
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09578-1702
Country	:	US
Telephone Number	:	979-218-5994
Fax Number	:

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

Provider Enumeration Date	:	08/13/2010
Last Update Date	:	08/13/2012

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Directions to “ SHAWNA ADAM D.D.S.” Practice Location

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