Provider Demographics
NPI:1407908643
Name:ADAMS, ROBERT WAGGONER (DDS)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:WAGGONER
Last Name:ADAMS
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 1:501 S HUGHES ST
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:MO
Mailing Address - Zip Code:64644-8230
Mailing Address - Country:US
Mailing Address - Phone:816-583-2750
Mailing Address - Fax:816-583-2934
Practice Address - Street 1:501 S HUGHES ST
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:MO
Practice Address - Zip Code:64644-8230
Practice Address - Country:US
Practice Address - Phone:816-583-2750
Practice Address - Fax:816-583-2934
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO11421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO680617141OtherEIN