Provider Demographics
NPI:1275845323
Name:PLASTER, ADAM (DDS)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:PLASTER
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 1:423 E MAIN ST
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BEDFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24523-2016
Mailing Address - Country:US
Mailing Address - Phone:540-586-3215
Mailing Address - Fax:540-586-3273
Practice Address - Street 1:423 E MAIN ST
Practice Address - Street 2:SUITE 2
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-2016
Practice Address - Country:US
Practice Address - Phone:540-586-3215
Practice Address - Fax:540-586-3273
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-06
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014101961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA9178673OtherDENTAQUEST
VA010119529Medicaid