Provider Demographics
NPI:1174604128
Name:ADAMS, NATHAN G (DMD, MD)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:G
Last Name:ADAMS
Suffix:
Gender:M
Credentials:DMD, MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 E 3900 S STE 360
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1362
Mailing Address - Country:US
Mailing Address - Phone:801-262-7447
Mailing Address - Fax:801-262-7450
Practice Address - Street 1:1250 E 3900 S STE 360
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84124-1362
Practice Address - Country:US
Practice Address - Phone:801-262-7447
Practice Address - Fax:801-262-7450
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7961990-9924204E00000X
UT7961990-1205204E00000X
MN54019204E00000X
MND12304204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN850000131Medicare PIN
V10476Medicare UPIN
MN850000098Medicare ID - Type Unspecified