Provider Demographics
NPI:1225111891
Name:ADAMS ORAL SURGERY INC
Entity Type:Organization
Organization Name:ADAMS ORAL SURGERY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:SCHEIVERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-637-5196
Mailing Address - Street 1:455 SOUTH WASHINGTON ST #21
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325
Mailing Address - Country:US
Mailing Address - Phone:717-337-3232
Mailing Address - Fax:717-337-1032
Practice Address - Street 1:455 SOUTH WASHINGTON ST #21
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325
Practice Address - Country:US
Practice Address - Phone:717-337-3232
Practice Address - Fax:717-337-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2007-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS022153L1223S0112X
PADS030876L1223S0112X
PADS0368011223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AD119905OtherBLUE SHIELD
R0535979OtherBLUE SHIELD DR G RONGIONE
055610QDGMedicare ID - Type UnspecifiedDR GREGORY RONGIONE
119905QDGMedicare ID - Type Unspecified
AD119905OtherBLUE SHIELD
T29229Medicare UPIN