Provider Demographics
NPI:1487195178
Name:CARRAWAY, ADAM BRUCE (DMD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:BRUCE
Last Name:CARRAWAY
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 1:2104 OLD SPARTANBURG RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-2763
Mailing Address - Country:US
Mailing Address - Phone:864-268-7812
Mailing Address - Fax:
Practice Address - Street 1:2104 OLD SPARTANBURG RD
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-2763
Practice Address - Country:US
Practice Address - Phone:864-268-7812
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-14
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC91361223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice