Provider Demographics
NPI:1083772438
Name:ADAMS, RICHARD CLAYTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:CLAYTON
Last Name:ADAMS
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 1:2641 LOCKWOOD RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28303-5020
Mailing Address - Country:US
Mailing Address - Phone:910-778-9746
Mailing Address - Fax:910-778-9746
Practice Address - Street 1:413 OWENS DRIVE
Practice Address - Street 2:SUITE 102
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-496-9400
Practice Address - Fax:910-496-9402
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC70541223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89902AXMedicaid
NCU89428Medicare UPIN