Provider Demographics
NPI:1407295546
Name:EIDSON, ADAM ROBERT (DDS)
Entity Type:Individual
Prefix:DR
First Name:ADAM
Middle Name:ROBERT
Last Name:EIDSON
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 1:6255 GRAND RIVER RD
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48114-5323
Mailing Address - Country:US
Mailing Address - Phone:810-522-4001
Mailing Address - Fax:
Practice Address - Street 1:6255 GRAND RIVER RD
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48114-5323
Practice Address - Country:US
Practice Address - Phone:810-522-4001
Practice Address - Fax:810-522-4001
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2023-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS039528122300000X, 1223S0112X
TX347481223S0112X
MI29016007341223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No122300000XDental ProvidersDentist