Basic Information
| Provider Information | |||||||||
| NPI: | 1578134193 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ADOLF | ||||||||
| FirstName: | THOMAS | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4323 HILL ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292076022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516209 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4323 HILL ST | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 292076022 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037516209 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2021 | ||||||||
| LastUpdateDate: | 07/06/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/06/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 12337263-9921 | UT | Y | Dental Providers | Dentist | General Practice | 1223G0001X | 12337263-8903 | UT | N | Dental Providers | Dentist | General Practice |
No ID Information.