Provider Demographics
NPI:1114139599
Name:PRISTERA, ADAM (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:
Last Name:PRISTERA
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 1:350 S 38TH CT STE 215
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-5777
Mailing Address - Country:US
Mailing Address - Phone:425-430-1320
Mailing Address - Fax:425-430-1319
Practice Address - Street 1:350 S 38TH CT STE 215
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055-5777
Practice Address - Country:US
Practice Address - Phone:425-430-1320
Practice Address - Fax:425-430-1319
Is Sole Proprietor?:No
Enumeration Date:2007-05-05
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053094122300000X
CT009648122300000X
WADE 605865041223X0400X, 1223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
No122300000XDental ProvidersDentist
No1223E0200XDental ProvidersDentistEndodontics