Provider Demographics
NPI:1083285506
Name:ADAMS, JEREMY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1703 MEADOWCLIFF DR
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76302-4811
Mailing Address - Country:US
Mailing Address - Phone:801-633-2942
Mailing Address - Fax:
Practice Address - Street 1:1802 N STATE ST
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-2027
Practice Address - Country:US
Practice Address - Phone:801-224-0320
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2022-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX373781223G0001X
UT12740510-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice