Provider Demographics
NPI:1174834048
Name:MERRIAM, ADAM SETH (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:SETH
Last Name:MERRIAM
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 1:1067 VISTA TRL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30324-4615
Mailing Address - Country:US
Mailing Address - Phone:646-265-8305
Mailing Address - Fax:
Practice Address - Street 1:4280 LAVISTA RD STE C117
Practice Address - Street 2:
Practice Address - City:TUCKER
Practice Address - State:GA
Practice Address - Zip Code:30084-5315
Practice Address - Country:US
Practice Address - Phone:678-688-4811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-06-25
Last Update Date:2023-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056657-11223S0112X
GADN0161161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery