Basic Information
| Provider Information | |||||||||
| NPI: | 1427499383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADAMO | ||||||||
| FirstName: | CHARLES | ||||||||
| MiddleName: | THOMAS | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS, MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8418 OLD MCGREGOR RD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767126494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547541456 | ||||||||
| FaxNumber: | 2547540907 | ||||||||
| Practice Location | |||||||||
| Address1: | 8418 OLD MCGREGOR RD | ||||||||
| Address2: | |||||||||
| City: | WACO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 767126494 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2547541456 | ||||||||
| FaxNumber: | 2547540907 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/08/2013 | ||||||||
| LastUpdateDate: | 07/08/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | 15885 | TX | N | Dental Providers | Dentist | 1223P0300X | 15885 | TX | Y | Dental Providers | Dentist | Periodontics |
No ID Information.