MEDICARE: DR SUSAN ADAMS

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	1223E0200X	Endodontics	015628	MO

General Provider Information

NPI Number	:	1891851515
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SUSAN ADAMS

Provider Business Mailing Address
First Line	:	15421 CLAYTON RD
Second Line	:	STE 102
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-391-8080
Fax Number	:	636-391-2266

Provider Business Practice Location Address
First Line	:	15421 CLAYTON RD
Second Line	:	STE 102
City	:	BALLWIN
State	:	MO
Zip	:	63011-3161
Country	:	US
Telephone Number	:	636-391-8080
Fax Number	:	636-391-2266

Authorized Official
Title or Position	:	DOCTOR
Name	:	SUSAN ADAMS
Credential	:	DMD
Telephone Number	:	636-391-8080

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/14/2008

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