Provider Demographics
NPI:1346308541
Name:FORD, ADAM
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:
Last Name:FORD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 E HOLMES AVE
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3372
Mailing Address - Country:US
Mailing Address - Phone:480-889-9457
Mailing Address - Fax:480-696-5505
Practice Address - Street 1:600 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-7927
Practice Address - Country:US
Practice Address - Phone:480-610-5100
Practice Address - Fax:480-610-5111
Is Sole Proprietor?:No
Enumeration Date:2006-12-04
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230241223G0001X
AZD0081961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice