Provider Demographics
NPI:1609940626
Name:ADAM, ELIZABETH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:ADAM
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 N. PIKE RD
Mailing Address - Street 2:PO BOX J
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055
Mailing Address - Country:US
Mailing Address - Phone:724-353-1521
Mailing Address - Fax:724-295-3749
Practice Address - Street 1:102 N. PIKE RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055
Practice Address - Country:US
Practice Address - Phone:724-353-1521
Practice Address - Fax:724-295-3749
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0365081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice