Provider Demographics
NPI:1275525347
Name:PERSHING, ADAM RYAN (DMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:RYAN
Last Name:PERSHING
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2300 N CRAYCROFT RD STE 4
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-2808
Mailing Address - Country:US
Mailing Address - Phone:520-722-2992
Mailing Address - Fax:520-722-2993
Practice Address - Street 1:2300 N CRAYCROFT RD STE 4
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-2808
Practice Address - Country:US
Practice Address - Phone:520-722-2992
Practice Address - Fax:520-722-2993
Is Sole Proprietor?:No
Enumeration Date:2005-08-16
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ71771223G0001X
IL019-0262371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice