Provider Demographics
NPI:1235444217
Name:ADAM, SHAWNA (DDS)
Entity Type:Individual
Prefix:
First Name:SHAWNA
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 LISBON CT APT 303
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23462-3192
Mailing Address - Country:US
Mailing Address - Phone:979-218-5994
Mailing Address - Fax:
Practice Address - Street 1:USS MESA VERDE (LPD 19)
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09578-1702
Practice Address - Country:US
Practice Address - Phone:979-218-5994
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25673122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist