Provider Demographics
NPI:1093381881
Name:STOTTS, ADAM WEEDEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:WEEDEN
Last Name:STOTTS
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 1:110 CEDAR LAKE DR
Mailing Address - Street 2:
Mailing Address - City:WENTZVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63385-5425
Mailing Address - Country:US
Mailing Address - Phone:636-887-1994
Mailing Address - Fax:
Practice Address - Street 1:505 INGRAM LN
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:MO
Practice Address - Zip Code:63383-4429
Practice Address - Country:US
Practice Address - Phone:636-377-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210195941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice