MEDICARE: DR. ADAM DAVID SERLO 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.)	2007-01894	NC
2	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	7806	NC

General Provider Information

NPI Number	:	1780886556
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADAM DAVID SERLO DMD, MD

Provider Business Mailing Address
First Line	:	501 EASTOWNE DRIVE
Second Line	:	SUITE 110
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514
Country	:	US
Telephone Number	:	919-929-2196
Fax Number	:	919-490-8518

Provider Business Practice Location Address
First Line	:	501 EASTOWNE DR
Second Line	:	SUITE 110
City	:	CHAPEL HILL
State	:	NC
Zip	:	27514-6224
Country	:	US
Telephone Number	:	919-929-2196
Fax Number	:	919-490-8518

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

Provider Enumeration Date	:	06/04/2007
Last Update Date	:	07/05/2008

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