Basic Information
Provider Information
NPI: 1548830987
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ADAMS
FirstName: JOHN
MiddleName: CHARLES
NamePrefix: DR.
NameSuffix:  
Credential: DMD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3085 COMMONWEALTH DR APT 1411
Address2:  
City: SPRING HILL
State: TN
PostalCode: 371743128
CountryCode: US
TelephoneNumber: 6013237397
FaxNumber:  
Practice Location
Address1: 4883 MAIN ST APT 1411
Address2:  
City: SPRING HILL
State: TN
PostalCode: 371742725
CountryCode: US
TelephoneNumber: 6155177858
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/28/2021
LastUpdateDate: 06/28/2021
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 06/28/2021

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
122300000X11642TNY Dental ProvidersDentist 

No ID Information.


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