MEDICARE: MR. JOHN S. ADAMS 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	1223G0001X	General Practice Dentistry	D7574	AZ

General Provider Information

NPI Number	:	1881847531
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JOHN S. ADAMS D.D.S.

Provider Business Mailing Address
First Line	:	501 ARMORY ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1337
Country	:	US
Telephone Number	:	480-389-9610
Fax Number	:

Provider Business Practice Location Address
First Line	:	731 W MAIN ST
Second Line	:
City	:	FREDERICKTOWN
State	:	MO
Zip	:	63645-1113
Country	:	US
Telephone Number	:	573-783-4100
Fax Number	:

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

Provider Enumeration Date	:	10/28/2008
Last Update Date	:	05/05/2010

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