Provider Demographics
NPI:1083627541
Name:EDWARDS, ADAM AMES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:AMES
Last Name:EDWARDS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 ARMSTRONG DR
Mailing Address - Street 2:
Mailing Address - City:ALTAMONT
Mailing Address - State:NY
Mailing Address - Zip Code:12009-9463
Mailing Address - Country:US
Mailing Address - Phone:518-861-5587
Mailing Address - Fax:
Practice Address - Street 1:103 MAIN ST
Practice Address - Street 2:
Practice Address - City:ALTAMONT
Practice Address - State:NY
Practice Address - Zip Code:12009-6234
Practice Address - Country:US
Practice Address - Phone:518-861-5136
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0361011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice