MEDICARE: ADAMS DENTAL GROUP

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	:	1598922700
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADAMS DENTAL GROUP

Provider Business Mailing Address
First Line	:	2119 MINNESOTA AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4145
Country	:	US
Telephone Number	:	913-621-3113
Fax Number	:

Provider Business Practice Location Address
First Line	:	2119 MINNESOTA AVE
Second Line	:
City	:	KANSAS CITY
State	:	KS
Zip	:	66102-4145
Country	:	US
Telephone Number	:	913-621-3113
Fax Number	:

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. MELISSA ROBERTS
Credential	:
Telephone Number	:	913-621-3113

Provider Enumeration Date	:	05/16/2008
Last Update Date	:	05/16/2008

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